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Importer Security Filing Request Form

102 WEST END AVENUE INWOOD, NY 11096


Phone (516) 887-2400 Fax (516) 887-8097

10+2 U. S. CUSTOMS
Importer Security Filing Request Form
MANUFACTURER (SUPPLIER) NAME AND ADDRESS SELLER NAME AND ADDRESS
EUCLIDES ERNESTO ALMEIDA ESCOBAR

EUCLIDES ERNESTO ALMEIDA ESCOBAR

KM 36 LOTIZACION "SANTA MARTHA"

KM 36 LOTIZACION "SANTA MARTHA"

EL CARMEN-MANABI-ECUADOR

EL CARMEN-MANABI-ECUADOR

BUYER NAME AND ADDRESS

SHIP TO NAME AND ADDRESS


EUCLIDES ERNESTO ALMEIDA ESCOBAR

BEMAR SNACKS INC


8000
WEST 26 AVENUE HIALEAH, FL 33016 U.S.A.
PHONE: 1-305-558-1210

KM 36 LOTIZACION "SANTA MARTHA"


EL CARMEN-MANABI-ECUADOR

CONTAINER STUFFING LOCATION

CONSOLIDATOR NAME AND ADDRESS

EUCLIDES ERNESTO ALMEIDA ESCOBAR

EUCLIDES ERNESTO ALMEIDA ESCOBAR

KM 36 LOTIZACION "SANTA MARTHA"

KM 36 LOTIZACION "SANTA MARTHA"

EL CARMEN-MANABI-ECUADOR

EL CARMEN-MANABI-ECUADOR

IMPORTER OF RECORD

CONSIGNEE

BEMAR SNACKS INC


8000
WEST 26 AVENUE HIALEAH, FL 33016 U.S.A.
PHONE: 1-305-558-1210

MASTER BILL OF LADING

BEMAR SNACKS INC


8000
WEST 26 AVENUE HIALEAH, FL 33016 U.S.A.
PHONE: 1-305-558-1210

HOUSE BILL OF LADING

CONTAINER NUMBER(S)

BK008936
VESSEL NAME

VOYAGE NUMBER

MADELEINE
COUNTRY OF ORIGIN
ECUADOR

INOU4970327

V-162NB
DEPARTURE PORT
GUAYAQUIL, ECUADOR

DEPARTURE DATE
AUGUST 29, 2014

COMMODITY HTSUS NUMBER

This form and a copy of the commercial invoice must be completed with all information and in English
and submitted to our office no later than 72 hours prior to sailing.

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