CHB Package – 3rd party

Follow the guided steps in the form to complete your registration. Each section is designed to ensure we gather the necessary details efficiently and securely. Once you’ve submitted the form, our team will review your information and contact you with the next steps.

CHB PACKAGE - 3RD PARTY

New Client Questionnaire

Type of Business

Individual

Corporation

Limited Liability Company

Sole Proprietorship

General Partnership

Limited Liability Partnership

Company Name

First Name

Last Name

Billing Address

City

State

ZIP Code

Country

Delivery Address (if different)

City

State

ZIP Code

Country

E.I.N or Customs Assigned Number:

Social Security Number or Customs Assigned Number:

DUNS#:

Power of Attorney - A1 Worldwide Logistics

Importer Information

Per Customs Regulation 19 C.F.R. 111.36(c)(3), I confirm this Power of Attorney is being completed by an approved signatory authorized to sign on behalf of the entity acting as the Importer of Record. By selecting this box, I confirm that I am NOT a freight forwarder or unlicensed third party acting on behalf of the Importer of Record.

Type of Business:

Government Issued Identification

Individuals importing into the US are required to provide a copy of a government issued ID. Examples include: Driver’s License, State Issued ID, Passport, Work Visa, Green card, DOD or Military ID

Upload a copy of your government issued ID

Choose File

Upload a copy of your social security card

Choose File

Name:

Social Security Number:

Sole Proprietorship

Per US Customs Regulations and based on your company’s entity, the US Customs Power of Attorney may only be completed by the Owner/Sole Proprietor of the company

Corporation

According to U.S. Customs regulations and specific to your company's legal structure, only the following individuals may complete the U.S. Customs Power of Attorney:

President
Executive Vice President Corporate
Secretary
Chief Executive Officer
Chief Fianancial Officer
Chief Information Officer
Chief Operating Officer
Treasurer

Limited Liability Company

Per US Customs Regulations and based on your company’s entity, the US Customs Power of Attorney may only be completed by the member/owner if registered as a Member Managed LLC and Manager(s) only if registered as a Manager Managed LLC.

Member Managed LLC:

Member/Owner

Manager Managed LLC:

Manager(s) Only

General Partnerships: US Customs Compliance

According to US Customs regulations, companies operating as general partnerships must submit a copy of their partnership agreement along with the US Customs Power of Attorney (POA). Only one member of the partnership is authorized to complete the POA. Please ensure to upload a PDF of the Partnership Agreement below for compliance and processing.

Partnership Agreement

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Limited Liability Partnerships: Ensuring Compliance with US Customs

As mandated by US Customs regulations, limited liability partnerships need to provide a copy of their partnership agreement when submitting the US Customs Power of Attorney (POA). It's important to note that only one member of the partnership is allowed to fill out the POA. For full compliance, please upload a PDF of your Partnership Agreement below.

Partnership Agreement

Choose File

Company name:

Do you have a registered DBA?

Yes

What is your DBA?

Is the company a foreign entity?

Tax ID# (EIN or Customs Assigned #):

Address: - - - -

I have read and agree to the Terms and Conditions

Power of Attorney

Acknowledgment of Terms & Conditions of Service

EIN/Customs Assigned Number:

SSN:

Make, endorse, sign, declare, or swear to any customs entry, withdrawal, declaration, certificate, bill of lading, carnet or any other documents required by law or regulation in connection with the importation, exportation, transportation, of any merchandise in or through the customs territory, shipped or consigned by or to said GRANTOR;

Perform any act or condition, which may be required by law or regulation in connection with such merchandise deliverable to said GRANTOR; to receive any merchandise;

Make endorsements on bills of lading conferring authority to transfer title; make entry or collect drawback; and to make, sign, declare, or swear to any statement or certificate required by law or regulation for drawback purposes, regardless of whether such document is intended for filing with Customs;

Sign, seal, and deliver for and as the act of said GRANTOR any bond required by law or regulation in connection with the entry or withdrawal of imported merchandise or merchandise exported with or without benefit of drawback, or in connection with the entry, clearance, lading, unlading or navigation of any vessel or other means of conveyance owned or operated by said GRANTOR, and any and all bonds which may be voluntarily given and accepted under applicable laws and regulations, consignee’s and owner’s declarations provided for in section 485, Tariff Act of 1930, as amended, or affidavits or statements in connection with the entry of merchandise;

Execute and affirm any documents and perform any actions that may be legally or regulatory required in relation to the entry, clearance, loading, unloading, or operation of any vessel or other means of transport owned or operated by the said GRANTOR;

Authorize other Customs Brokers, who are duly licensed within the territory, to act as the GRANTOR’s agent. This includes the authority to receive, endorse, and collect checks issued for Customs duty refunds in the GRANTOR’s name, drawn on the Treasurer of the United States. If the GRANTOR is a nonresident of the United States, this authorization also includes the acceptance of service of process on behalf of the GRANTOR.

Additionally, it grants the power to generally transact Customs business, which includes the filing of claims or protests under section 514 of the Tariff Act of 1930, or pursuant to other relevant laws of the territories. This encompasses any matters in which the GRANTOR is, or may be, concerned or interested and that can appropriately be transacted or performed by an agent and attorney.

Granting the said agent and attorney complete authority to undertake all necessary actions required in this matter, just as if the Grantor were present and taking those actions personally, and fully ratifying and confirming all that the said agent and attorney shall lawfully do under this authority;

This power of attorney shall remain effective until a written revocation notice is properly delivered to and received by the grantee (if the Grantor is a partnership, this power of attorney shall not be valid in the United States beyond two years from the date it was executed);

Appointment as Forwarding Agent: GRANTOR authorizes the above Grantee to act within the territory as lawful agent and sign or endorse export documents (i.e. commercial invoices, bill of lading, insurance certificates, drafts and any other document) necessary for the completion of an export on Grantor’s behalf as may be required under law and regulation in the territory and to appoint forwarding agents on Grantor’s behalf;

If you are the importer of record, payment to the broker will not relieve you of liability for customs charges (duties, taxes, or other debts owed CBP) in the event the charges are not paid by the broker. Therefore, if you pay by check, customs charges may be paid with a separate check payable to the “US Customs and Border Protection” which will be delivered to CBP by the broker.

GRANTOR acknowledges receipt of A1 Worldwide Logistics, Inc Terms & Conditions of Service governing all transactions between the Parties.

Signatory certifies that he/she has full authority to execute this power on behalf of the GRANTOR.

IN WITNESS WHEREOF, the said (“GRANTOR”) doing business as a caused these presents to be sealed and signed.

Perform any act or condition, which may be required by law or regulation in connection with such merchandise deliverable to said GRANTOR; to receive any merchandise;

GRANTOR acknowledges receipt of A1 Worldwide Logistics, Inc Terms & Conditions of Service governing all transactions between the Parties.

Signatory certifies that he/she has full authority to execute this power on behalf of the GRANTOR.

IN WITNESS WHEREOF, the said (“GRANTOR”) doing business as a caused these presents to be sealed and signed.

KNOW ALL MEN BY THESE PRESENTS: That, (“Grantor”) doing business as a under the laws of the State of , , residing or having a principal place of business at , , , , , hereby constitutes and appoints A1 WORLDWIDE LOGISTICS, Inc.,(“Grantee”) its officers, employees, and/or specifically authorized agents, to act for and on its behalf as a true and lawful agent and attorney of the GRANTOR for and in the name, place and stead of said GRANTOR, from this date, in the United States (the “TERRITORY”) either in writing, electronically, or by other authorized means, to:

Make, endorse, sign, declare, or swear to any customs entry, withdrawal, declaration, certificate, bill of lading, carnet or any other documents required by law or regulation in connection with the importation, exportation, transportation, of any merchandise in or through the customs territory, shipped or consigned by or to said GRANTOR;

Perform any act or condition, which may be required by law or regulation in connection with such merchandise deliverable to said GRANTOR; to receive any merchandise;

Make endorsements on bills of lading conferring authority to transfer title; make entry or collect drawback; and to make, sign, declare, or swear to any statement or certificate required by law or regulation for drawback purposes, regardless of whether such document is intended for filing with Customs;

Sign, seal, and deliver for and as the act of said GRANTOR any bond required by law or regulation in connection with the entry or withdrawal of imported merchandise or merchandise exported with or without benefit of drawback, or in connection with the entry, clearance, lading, unlading or navigation of any vessel or other means of conveyance owned or operated by said GRANTOR, and any and all bonds which may be voluntarily given and accepted under applicable laws and regulations, consignee’s and owner’s declarations provided for in section 485, Tariff Act of 1930, as amended, or affidavits or statements in connection with the entry of merchandise;

Execute and affirm any documents and perform any actions that may be legally or regulatory required in relation to the entry, clearance, loading, unloading, or operation of any vessel or other means of transport owned or operated by the said GRANTOR;

Authorize other Customs Brokers, who are duly licensed within the territory, to act as the GRANTOR’s agent. This includes the authority to receive, endorse, and collect checks issued for Customs duty refunds in the GRANTOR’s name, drawn on the Treasurer of the United States. If the GRANTOR is a nonresident of the United States, this authorization also includes the acceptance of service of process on behalf of the GRANTOR.

Additionally, it grants the power to generally transact Customs business, which includes the filing of claims or protests under section 514 of the Tariff Act of 1930, or pursuant to other relevant laws of the territories. This encompasses any matters in which the GRANTOR is, or may be, concerned or interested and that can appropriately be transacted or performed by an agent and attorney.

Granting the said agent and attorney complete authority to undertake all necessary actions required in this matter, just as if the Grantor were present and taking those actions personally, and fully ratifying and confirming all that the said agent and attorney shall lawfully do under this authority;

This power of attorney shall remain effective until a written revocation notice is properly delivered to and received by the grantee (if the Grantor is a partnership, this power of attorney shall not be valid in the United States beyond two years from the date it was executed);

Appointment as Forwarding Agent: GRANTOR authorizes the above Grantee to act within the territory as lawful agent and sign or endorse export documents (i.e. commercial invoices, bill of lading, insurance certificates, drafts and any other document) necessary for the completion of an export on Grantor’s behalf as may be required under law and regulation in the territory and to appoint forwarding agents on Grantor’s behalf;

If you are the importer of record, payment to the broker will not relieve you of liability for customs charges (duties, taxes, or other debts owed CBP) in the event the charges are not paid by the broker. Therefore, if you pay by check, customs charges may be paid with a separate check payable to the “US Customs and Border Protection” which will be delivered to CBP by the broker.

GRANTOR acknowledges receipt of A1 Worldwide Logistics, Inc Terms & Conditions of Service governing all transactions between the Parties.

Signatory certifies that he/she has full authority to execute this power on behalf of the GRANTOR.

IN WITNESS WHEREOF, the said (“GRANTOR”) caused these presents to be sealed and signed.

Signature

Capacity/Title

By checking this box, I acknowledge and agree that I am providing my electronic signature.

Full Name of Signer

Phone Number of Signer

Email Address of Signer

C-TPAT SECURITY QUESTIONNAIRE

Name:

Company Name:

Address: , , , ,

Name of the Person Completing Form:

Title:

Email:

Telephone:

Is your company currently CTPAT certified?

YES

Are you currently CTPAT certified?

YES

If YES, initiate an SVI monitoring request by doing the following: 1) Log in to your C-TPAT Portal account; 2) Select the "Status Verification" link; 3) Select the "Request Monitoring" tab; 4) Enter our company's name in the search box (you must enter at least three characters); 5) Our company will show in the list that appears; 6) Click the "Select box" next to our company name.

Has your company started the process of becoming C-TPAT certified?

YES

Have you started the process of becoming C-TPAT certified?

YES

Have you made an analysis of your existing security criteria and procedures?

YES

Have you submitted the online business profile on the C-TPAT web portal?

YES

Have you started the process of completing the online security profile on the C-TPAT web portal?

YES

Have you submitted the online security profile on the C-TPAT web portal?

YES

Does your company participate in any of the following government sponsored supply chain security programs?: Export Scheme Program (New Zeland), Partners in Protection (Canada), Golden List Program (Jordan), Authorized Economic Operator (Japan, Korea, European Union, Taiwan or Israel), NEEC- Nuevo Esquema de Empresa Certificada (Mexico), Secure Trade Partnership (Singapore), Other program.

YES

Do you participate in any of the following government sponsored supply chain security programs?: Export Scheme Program (New Zeland), Partners in Protection (Canada), Golden List Program (Jordan), Authorized Economic Operator (Japan, Korea, European Union, Taiwan or Israel), NEEC- Nuevo Esquema de Empresa Certificada (Mexico), Secure Trade Partnership (Singapore), Other program.

YES

Indicate below in which government sponsored supply chain programs you participate:

Export Scheme Program (New Zeland)

YES

Partners in Protection (Canada)

YES

Golden List Program (Jordan)

YES

Authorized Economic Operator (Japan)

YES

Authorized Economic Operator (Korea)

YES

Authorized Economic Operator (European Union)

YES

Authorized Economic Operator (Taiwan)

YES

Authorized Economic Operator (Israel)

YES

NEEC (Nuevo Esquema de Empresa Certificada (Mexico)

YES

Secure Trade Partnership (Singapore)

YES

Do you participate in any other government sponsored supply chain program?

YES

Name of the program

Provide copies of all certificates and pertinent documents

Choose File

Signature of the person completing this questionnaire:

IMPORTER-BROKER-FREIGHT FORWARDER AND THIRD PARTY AGREEMENT

We, the importer of record, understand that A1 Worldwide Logistics, Inc. will be Customs Broker of Record.

We, the importer of record hereby authorize A1 Worldwide Logistics, Inc to invoice brokerage charges on our behalf to:

We, the importer of record, may contact A1 Worldwide Logistics, Inc. for customs related issues or concerns.

Importer of Record:

IRS Number:

Signature:

Print Name:

Title:

A1 Worldwide Logistics, Inc. in making this agreement and in all actions taken pursuant to the agreement remains subject to all provisions of 19 CFR 111.