要去美國, 行前需知(1)

1.   Family Name

First (Given)

姓

名

2. Birth date

出生日期

3. Number of Family Members traveling with you (do not include yourself)

家庭同行成員(並不包括你自己)

4. U.S. Street Address

在美住所a.街道/ 號碼 b. 城市 c. 州

5. Passport issued by (country)

簽證簽發國家

6. Passport number

護照號碼

7. Country of Residence

居住國家

8. Countries visited on this trip prior to U.S. arrival

旅美前曾赴哪些國家

9. Airline/ Fight No.

航空公司/ 班機號碼

10. Mark an X in the Yes or No box. Are you traveling on a business trip?

請在Yes或No以「X」標示回答。

來美的目的是商務目的嗎？

11. I’m bringing

(a)  fruits, plants, food, or insects?

(b)  meats, animals, or animal/ wildlife products?

(c)  disease agents, cell cultures, or snails?

(d)  soil or have you visited a farm/ ranch/ pasture outside the United States ?

請在Yes 或No 以「X」標示回答。

是否攜帶？

(a)  水果、植物、食物或昆蟲？

(b)  肉類、動物、動物製品或野生動植物製品？

(c)   帶病原體、細胞培養菌或鍋牛？

(d)  土壤或你曾經去過美國境外的農場或牧場？

12. Have you or any family members traveling with you been in close proximity of (such as touching or handling) livestock outside the United States ?

你或同行的家庭成員曾在美國境外與家畜有過近距離的接觸嗎(如觸摸等等)？

13. Are you or any family members traveling with you bringing $10,000 or more in U.S. dollars or foreign equivalent in any form into the United States ?

你或同行的家庭成員攜帶現金、外幣或其他等同現金的財物品，其價值超過一萬美金或相當於一萬美金嗎？(如：硬幣、現鈔、銀行支票、旅行支票、匯票、股票、債券等)如是，你必須填寫4790表格。

14. Are you or any family members traveling with you bringing commercial merchandise into the United States ?

你或同行的家庭成員有攜帶商品進入美國嗎？

(商品如：販賣的物品、商業樣品或任何不屬於個人的物品)

15. Print the total value of all goods (including commercial merchandise) you or any family members traveling with you are bringing into the United States and will remain in the United States .

請寫下你或同行家人將攜帶美國境內的所有物品價值(包含商品)為：

Declare all articles on this form. For gifts, please indicate the retail value. Use the reverse side of this form if additional space is needed to list the items you will declare. Note: Visitors (non-U.S. Residents) are normally entitled to an exemption of $100.

請閱讀過背面的說明。如有攜帶禮品，請列出其零售價格。請將須申報的物品在空格內列出。免稅額之物品，為價值100美元內，如超過100美元，依當時稅率扣稅。