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APPENDIX B

(OMB No. 2133-0013 applies to this collection of information.)

PR-17 WAIVER REQUEST - FORMAT

The below information is required to process a Statutory or Conditional Waiver request. This information should be mailed or faxed to Office of Cargo Preference, Room 8118, Maritime Administration, 400 Seventh Street, SW, Washington, DC 20590. Fax number is 202-366-5522. Electronic mail address is cargo.marad@marad.dot.gov

RE: GOVERNMENT INSTRUMENTALITY CREDIT NO. (Enter the number)- Country (Enter Country name)

APPLICANT: (Name of company seeking the waiver. Should be the cargo manufacturer or beneficial owner. If a freight forwarder or other party makes the application, it must clearly state on whose behalf it is seeking the waiver and that it legally represents said party.)

VESSEL: (Name of vessel you propose to use. Enter "To Be Named" if unknown. Note that actual vessel must be named before a final waiver can be issued. Shippers should be aware that PL 105-383 prohibits the carriage of preference cargoes on substandard vessels. See the MARAD web site.)

REGISTRY: (Nation of registry of vessel. Enter "To Be Named" if unknown.)

COMMODITY: (Short, one-line description similar to Acquisition List line items. Attach detailed description as part of packing list or similar document.)

WEIGHT: (Total weight in kilos. Attach details of individual shipping components with dimensions and weights as part of packing list or similar document.)

VOLUME: (Total volume in cubic meters. Attach details of individual shipping components with dimensions and weights as part of packing list or similar document.)

REVENUE TONS: (shipper’s estimate of cargo revenue tons.)

VALUE OF SHIPMENT: (FAS value in US dollars)

OCEAN FREIGHT: (Actual or estimated ocean freight charges from the carrier whom the applicant proposes to use.)

LOADING PORT: (Desired port to load cargo.)

LOADING DATE: (Date when cargo will be ready to load.)

DISCHARGE PORT: (Desired port of destination for ocean carriers.)

WRITTEN REASON(s) FOR THE WAIVER REQUEST WITH DOCUMENTATION SUPPORTING EACH REASON ATTACHED

The following language must be included in any waiver request above the signatory block:

"This application is made for the purpose of inducing the United States of America to grant a waiver of Public Resolution 17 and the policy prescribed to carry out the provisions of PR-17. I have carefully examined the application and all documents submitted in connection therewith and, to the best of my knowledge, information and belief, the statements and representatives contained in said application and related documents are full, complete, accurate and true.

Signature:

Name (typed):

Title:

Date:"

THE FOLLOWING DOCUMENTS MUST BE ATTACHED:

1. Copy of the "Request for Quotations (RFQ)" package which the shipper sent to the carriers. The RFQ should contain the most detailed information available regarding the commodities, sizes and weights. A packing list is preferable.
   
2. A list of all carriers, with names of personnel, to whom the RFQ was sent.
   
3. Copies of responses received from any U.S.-flag carriers.
   
4. Documentation supporting each reason justifying the need for a waiver. For example, a contract problem requires a copy of the applicable contract clauses; a letter of credit problem requires a copy of the L/C; U.S.-flag service not available requires copies of written declinations by the U.S. carriers; etc.

NOTE: The essential terms of the waiver application and cargo shipment information will be posted on the Maritime Administration web site but restricted to bona fide U.S.-flag carriers.

NOTE: The U.S. Criminal Code makes it a criminal offense for any person knowingly to make a false statement or representation to, or to conceal a material fact from, any department or agency of the United States as to any matter within its jurisdiction (18 U.S.C. 1001), or to file a false, fictitious or fraudulent claim against the United States (18 U.S.C. 287). Civil fraud may incur fines of $10,000 plus 3 times damages and expenses of government recovery. Criminal fraud provides up to 5 years imprisonment. In addition, entities may be debarred from further Government contracts.