Fun學隊長

Each arriving traveler or head of family must provide the following information (only ONE written declaration per family is required):

每位入關的旅遊者或一家之主必須提供以下資料 (一個家庭只須申報一份)：

Family Name ________First (Given)________ Middle________

姓            氏 ________名           字_______  中間名________

Birth date ____Day____Month____Year

出生日期           日 ___ _ 月    ____年

Number of family members traveling with you  與你同行的家庭成員人數

(a) U.S. Street Address (hotel name / destination)  在美地址街名 (旅館名稱 / 目的地)

(b) City 城市   (c) State 州名   

 The primary purpose of this trip is business:  口Yes 口No  本次旅遊的目的是商務：口是 口否

 I am (we are) bringing (a) fruits, vegetables, plants, seeds, food, insects: (b) meats, animals, animal/wildlife products: (c) disease agents, cell cultures, snails: (d) soil or have been on a farm/ranch/pasture:

 我(我們)攜帶 (a) 水果、植物、食品、昆蟲： (b) 肉類、動物、動物/野生動物製品： (c) 病源、細胞培養物、蝸牛： (d) 泥土或暫住過在農村或牧場嗎？

 I have (We have) been in close proximity of livestock (such as touching or handling):

我(我們)曾經非常接近牲畜(如摸過或處理過)：

  I am (We are) carrying currency or monetary instruments over $10,000 U.S. or foreign equivalent:

 我(我們)攜帶了超過$10,000美元或等值外幣的貨幣或金融票據：

  I have (We have) commercial merchandise: (articles for sale, samples used for soliciting orders, or goods that are not considered personal effects)

您有攜帶任何商品嗎？(販售之商品、訂購之樣本等任何非屬私人之物品)

 RESIDENTS—the total value of all goods, including commercial merchandise I/we have purchased or acquired abroad, (including gifts for someone else but not items mailed to the U.S.) and am/are bringing to the U.S. is: $          

居民 - 我(我們)在國外購買或取得並帶到美國的所有物品(包括商品及為別人所帶的禮品，但不包括郵寄到美國的物品)總價值為：$          美元

 VISITORS—the total value of all articles that will remain in the U.S., including commercial merchandise is: $          

訪客 - 將留在美國的所有物品(包括商品)的總價值為：$          美元

 I HAVE READ THE IMPORTANT INFORMATION ON THE REVERSE SIDE OF THIS FORM AND HAVE MADE A TRUTHFUL DECLARATION.

請閱讀本申請表背面的說明。空白處供您列出所有必須申報的物品。本人以閱讀過本申報表背面的重要說明，並且以如實申報。

Signature 簽名          Date(day/month/year 日期(日/月/年)