WELCOME TO THE UNITED STATES      |       |      欢迎来到美国      | 
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     DEPARTMENT OF THE TREASURY     UNITED STATES CUSTOMS SERVICE      |       |      财政部     美国海关署      | 
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     CUSTOM DECLARATION      |       |      海关申报表      | 
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     Each arriving traveler or head of family must provide the following information (only ONE written declaration per family is required):      |       |      每位入关的旅游者或一家之主必须提供以下数据 (一个家庭只须申报一份):      | 
     1. Family Name ________First (Given)________ Middle________      |       |      1. 姓氏 ________名字_______ 中间名________      | 
     2. Birth date      |       |      2.  出生日期:      | 
     ____Day____Month____Year      |       |      ____日____ 月____年      | 
     3. Number of family members traveling with you:      |       |      3. 与你同行的家庭成员人数:      | 
     4. U.S. Address:      |       |      4. 在美地址:      | 
     5. Passport issued by (country)      |       |      5. 护照发照(国家)      | 
     6. Passport Number      |       |      6. 护照号码      | 
     7. Country of Residence      |       |      7. 居住国家      | 
     8. Countries visited on this trip prior to U.S. arrival      |       |      8. 到美国前造访过的国家      | 
     9. Airline/Flight No:      |       |      9. 航空公司/航班号:      | 
     10. The primary purpose of this trip is     business.    ○YES ○ NO      |       |      10. 此次旅程的主要目的是商务?○ 是   ○ 否      | 
| 11. I am/we are bringing fruits, plants, meats, food, soil, birds, snails, other live animals, farm products, or I/we have been on a farm or ranch outside the U.S.YES ○  NO ○ |       | 11. 您携带水果、植物、肉类、食品、土壤、鸟类、蜗牛、其它动物和农产品,或您一直居住在美国以外的农村或牧场吗?是 ○ 否 ○ | 
| 12. I am/we are carrying currency or monetary instruments over $10000 U.S. or the foreign equivalent.YES ○  NO ○ |       | 12. 您携带现金或珍贵物品,其价值超过一 万美金或相当于一万美金的外币吗?是 ○ 否 ○ | 
| 13. I have (We have) commercial merchandise? (articles for sale, samples used for soliciting orders, or goods that are not considered personal effects.)YES ○  NO ○ |       | 13. 您有携带任何商品吗?(贩卖之商品、订购之样本等任何非属私人之物品)是 ○ 否 ○ | 
     14. The total value of all goods I/we purchased or acquired abroad and am/are bringing to the U.S. is (see instructions under Merchandise on reverse side; visitors should report value of gifts only):$___________________ U.S. Dollars      |       |      14. 您境外购买或获得并带入美国所有物品总价值(参看 背面商品栏目; 访问者只须申报礼品价值): $ _________________ 美元      | 
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     I have read the important information on the reverse side of this form and have made a truthful declaration.      |       |      我已阅读过这表格背面之重要须知,并据实以报。      | 
     SIGNATURE________________      |       |      签名________________      | 
     Date________________      |       |      日期________________      |