Postage Statement International Mail Use this form for all International Mailings. Only one part may be completed per mailing.

Transcription

1 United States Postal Statement International Mail Use this form for all International Mailings. Only one part may be completed per mailing. Post Office: Note Mail Arrival Date & Time (Do Not Round-Stamp) Permit Holder Name, Address, , Telephone Mailing Agent (If other than permit holder) Name, Address, Telephone Mail Owner (If other than permit holder) Name, Address Mailer CAPS Cust. Ref. No. CRID CRID CRID Post Office of Mailing Mailer s Mailing Date Permit # Federal Agency Cost Code Statement Seq. No. No. & Type of Containers Mailing Type of Metered Permit Imprint Precanceled Stamps Partial Permit Imprint (For Part A, C, D only) Letters Flats Mixed (C & D only) Packages Of total pcs., # of USPS-Supplied GXG Legal-Size Envs. (Part H Only) M-bags Weight of a Single Piece. Weight (Less tare) Receipt No. Tare Weight Sacks Trays Flat Trays Pallets Check box if mailing is under an ICM Agreement and enter ICM Agreement No. (if applicable) Direct ment (Specify Country) Other Parts Completed (Select one): A B C D E F G H P Q R Tier (Select one): N / A Com Base Com Plus GEPS Select if any extra services are included: S 1 (Add parts totals) 2 at Which Affixed (Check one). Correct Lowest Neither Complete if mailing includes pieces bearing metered/pc or precanceled stamps. pcs. x $. = Affixed - 3 Incentive/Discount Flat Dollar Amount - 4 Flat Dollar Amount + 5 Permit # Net Due (Line 1 +/- Lines 2, 3, 4) USPS Use Only Additional Payment (State reason) For postage affixed, add additional payment to net postage due; for permit imprint, add additional payment to total postage. Permit Imprint Only Check One Report in AIC AIC 234 (ISAL) AIC 235 (IPA) AIC 243 (FCMI, FCPIS) AIC 244 (PMI, PMEI, GXG) AIC 245 (M-Bag Airmail) AIC 246 (Global Direct, Comm epacket) Adjusted Affixed Adjusted Permit Imprint Certification Incentive/Discount Claimed: Type of : The mailer s signature certifies acceptance by the Mailer of liability for and agreement to pay any revenue deficiencies assessed on this mailing, subject to appeal. If an agent signs this form, the agent certifies that he or she is authorized to sign on behalf of the mailer and that the mailer is bound by the certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their responsibility, knowledge, or control. The mailer hereby certifies that all information furnished on this form is accurate, truthful, and complete; that the mail and the supporting documentation comply with all postal standards and the mailing qualifies for the prices and fees claimed; and this mailing does not contain any dangerous articles, or articles prohibited by legislation or by postal or customs regulations. The mailer hereby certifies that this mailing is in compliance with all applicable export laws, regulations, or orders and certifies that the mailer has provided any necessary documentation required by the USPS, the U.S. Government, or destination country foreign government, or other authority. See the International Mail Manual for additional information. The mailer agrees to indemnify the United States Postal from any and all claims, losses, costs, damages or expenses incurred by USPS as a result of mailer s failure to comply with any applicable laws or regulations. The mailer understands that anyone who furnishes false or misleading information on this form or who omits information requested on this form may be subject to criminal and/or civil penalties, including fines and imprisonment. Privacy Notice: For information regarding our Privacy Policy visit Signature of Mailer or Agent Printed Name of Mailer or Agent Signing Form Telephone USPS Use Only To be completed in non-postalone! sites Weight of a Single Piece. pounds Weight Presort Verification Performed? (If required) Yes No I CERTIFY that this mailing has been inspected for each item below if required: (1) eligibility for postage prices claimed; (2) proper preparation (and presort where required); (3) proper completion of postage statement; (4) payment of annual fee; and (5) sufficient funds on deposit (if required) USPS Employee s Signature Are postage figures at left adjusted from mailer s entries? Yes No If yes, reason: Date Mailer Notified Contact By (Initials) Time AM PM Print USPS Employee s Name Round Stamp (Required) Payment Date PS Form , January 2018 (Page 1 of 19) PSN This form and mailing standards are available on Postal Explorer at pe.usps.com.

2 First-Class Mail International Permit Imprint Part A Postcards Destination Country Per Piece Discount A1 Canada/Mexico $1.15 A2 All Other Countries 1.15 Letters (up to 3.5 ounces) and Flats (up to 4 pounds) A3 A4 Destination Country/ No. of Per Piece Discount 1 (Canada) 2 (Mexico) A5 3 A6 4 A7 5 A8 6 A9 7 A10 8 A11 9 A12 Nonmachinable Surcharge (letters only, up to 3.5 ounces) M-Bag Airmail $0.21 No. Sacks Per Sack Sack lbs. of All Sacks Over 11 lbs. Per Pound Discount A13 1 $48.40 $4.40 A A A A A A A A A22 (add lines A1 A21) ICM Incentive (if applicable) % Incentive (A22) Incentive A23 Incentive Percentage = X = - Part A (line A22 minus A23) PS Form 3700, January 2018 (Page 2 of 19)

3 First-Class Package International Permit Imprint Part B Com Base, Com Plus, GEPS/NSA Packages/Small Packets (up to 4 pounds) B1 B2 Destination Country/ No. of Per Piece Discount 1 (Canada) 2 (Mexico) B3 3 B4 4 B5 5 B6 6 B7 7 B8 8 B9 9 Part B (Add lines B1 B9) PS Form , January 2018 (Page 3 of 19) PSN

4 International Surface Air Lift ISAL Permit Imprint Part C Postcards/Letters, Flats and Packages (Small Packets) Category No. of Piece ISC Drop Discount Piece & C1 WW* Mixed $0.61 $12.33 $9.72 C2 15 Direct C3 15 Mixed C4 16 Direct C5 16 Mixed C6 17 Direct C7 17 Mixed C8 18 Direct C9 18 Mixed C10 19 Direct C11 19 Mixed * Worldwide Nonpresort Postcards/Letters (up to 3.5 ounces) Category No. of Piece ISC Drop Discount Piece & C12 1 Direct $0.57 $7.64 $5.16 C13 2 Direct C14 3 Direct C15 4 Direct C16 5 Direct C17 6 Direct C18 7 Direct C19 8 Direct C20 9 Direct C21 9 Mixed C22 10 Direct C23 10 Mixed C24 11 Direct C25 11 Mixed C26 12 Direct C27 12 Mixed C28 13 Direct C29 13 Mixed C30 14 Direct C31 14 Mixed Part C continued on next page PS Form 3700, January 2018 (Page 4 of 19)

5 International Surface Air Lift ISAL Permit Imprint Part C Continued Flats (up to 17.6 ounces) Category No. of Piece ISC Drop Discount Piece & C32 1 Direct $0.57 $6.51 $4.42 C33 2 Direct C34 3 Direct C35 4 Direct C36 5 Direct C37 6 Direct C38 7 Direct C39 8 Direct C40 9 Direct C41 9 Mixed C42 10 Direct C43 10 Mixed C44 11 Direct C45 11 Mixed C46 12 Direct C47 12 Mixed C48 13 Direct C49 13 Mixed C50 14 Direct C51 14 Mixed Packages (Small Packets) (up to 4.4 pounds) Category No. of Piece ISC Drop Discount Piece & C52 1 Direct $0.57 $6.22 $4.21 C53 2 Direct C54 3 Direct C55 4 Direct C56 5 Direct C57 6 Direct C58 7 Direct C59 8 Direct C60 9 Direct C61 9 Mixed C62 10 Direct C63 10 Mixed C64 11 Direct C65 11 Mixed C66 12 Direct C67 12 Mixed C68 13 Direct C69 13 Mixed C70 14 Direct C71 14 Mixed C72 (add lines C1 C71) Part C continued on next page PS Form , January 2018 (Page 5 of 19) PSN

6 International Surface Air Lift ISAL Permit Imprint Part C Continued International Surface Air Lift-M-Bag-ISAL No. Sacks ISC Drop Sacks lbs. of All Sacks over 11 lbs. ISC Drop lbs. of Any ISC Sack Less Than 11 lbs. ISC Drop 5-11 lb. Incentive C73 1 $21.78 $20.93 $1.98 $1.90 $-0.14 C C C C C C C C C C C C C C C C C C Lbs. Discount Part C total (add lines C72 and C73 C91) PS Form 3700, January 2018 (Page 6 of 19)

7 International Priority Airmail IPA Permit Imprint Part D Postcards/Letters, Flats and Packages (Small Packets) Category No. of Piece ISC Drop Discount Piece & D1 WW* Mixed $0.66 $13.38 $10.54 D2 15 Direct D3 15 Mixed D4 16 Direct D5 16 Mixed D6 17 Direct D7 17 Mixed D8 18 Direct D9 18 Mixed D10 19 Direct D11 19 Mixed * Worldwide Nonpresort Postcards/Letters (up to 3.5 ounces) Category No. of Piece ISC Drop Discount Piece & D12 1 Direct $0.62 $7.84 $5.31 D13 2 Direct D14 3 Direct D15 4 Direct D16 5 Direct D17 6 Direct D18 7 Direct D19 8 Direct D20 9 Direct D21 9 Mixed D22 10 Direct D23 10 Mixed D24 11 Direct D25 11 Mixed D26 12 Direct D27 12 Mixed D28 13 Direct D29 13 Mixed D30 14 Direct D31 14 Mixed Part D continued on next page PS Form , January 2018 (Page 7 of 19) PSN

8 International Priority Airmail IPA Permit Imprint Part D Continued Flats (up to 17.6 ounces) Category No. of Piece ISC Drop Discount Piece & D32 1 Direct $0.62 $6.69 $4.56 D33 2 Direct D34 3 Direct D35 4 Direct D36 5 Direct D37 6 Direct D38 7 Direct D39 8 Direct D40 9 Direct D41 9 Mixed D42 10 Direct D43 10 Mixed D44 11 Direct D45 11 Mixed D46 12 Direct D47 12 Mixed D48 13 Direct D49 13 Mixed D50 14 Direct D51 14 Mixed Packages (Small Packets) (up to 4.4 pounds) Category No. of Piece ISC Drop Discount Piece & D52 1 Direct $0.62 $6.39 $4.34 D53 2 Direct D54 3 Direct D55 4 Direct D56 5 Direct D57 6 Direct D58 7 Direct D59 8 Direct D60 9 Direct D61 9 Mixed D62 10 Direct D63 10 Mixed D64 11 Direct D65 11 Mixed D66 12 Direct D67 12 Mixed D68 13 Direct D69 13 Mixed D70 14 Direct D71 14 Mixed D72 (add lines D1 D71) Part D continued on next page PS Form 3700, January 2018 (Page 8 of 19)

9 International Priority Airmail IPA Permit Imprint Part D Continued International Priority Airmail-M-Bag-IPA No. Sacks ISC Drop Sacks lbs. of All Sacks over 11 lbs. ISC Drop lbs. of Any ISC Sack Less Than 11 lbs. ISC Drop 5-11 lb. Incentive D73 1 $62.70 $27.15 $5.70 $2.48 $-0.43 D D D D D D D D D D D D D D D D D D Lbs. Discount Part D (add lines D72 and D73 D91) PS Form , January 2018 (Page 9 of 19) PSN

10 Priority Mail International Permit Imprint Transmits Customs Data Part E Com Base, Com Plus, GEPS/NSA Priority Mail International E1 E2 E3 No. of Discount 1 - Montreal 1 - Toronto 1 - Vancouver E4 2 E5 3 E6 4 E7 5 E8 6 E9 7 E10 8 E11 9 E12 10 E13 11 E14 12 E15 13 E16 14 E17 15 E18 16 E19 17 Flat Rate Envelopes (Individual Weight Limit: 4 lbs.) (15" x 9 1/2" or Smaller USPS-Produced) No. of Per Piece Discount E20 1 E21 2 E22 3 E23 4 E24 5 E25 6 E26 7 E27 8 E28 9 E29 10 PS Form 3700, January 2018 (Page 10 of 19) Part E continued on next page

11 Priority Mail International Permit Imprint Transmits Customs Data Part E Continued Com Base, Com Plus, GEPS/NSA Padded Flat Rate Envelopes (Individual Weight Limit: 4 lbs.) No. of Discount E30 1 E31 2 E32 3 E33 4 E34 5 E35 6 E36 7 E37 8 E38 9 E39 10 Small Flat Rate Boxes (Individual Weight Limit: 4 lbs.) (Including items O-Small FRBX, ODVDS, and O-1096-L) No. of Per Piece Discount E40 1 E41 2 E42 3 E43 4 E44 5 E45 6 E46 7 E47 8 E48 9 E49 10 Medium Flat Rate Boxes (Individual Weight Limit: 20 lbs.) No. of Per Piece Discount E50 1 E51 2 E52 3 E53 4 E54 5 E55 6 E56 7 E57 8 E58 9 E59 10 PS Form , January 2018 (Page 11 of 19) PSN Part E continued on next page

12 Priority Mail International Permit Imprint Transmits Customs Data Part E Continued Com Base, Com Plus, GEPS/NSA Large Flat Rate Boxes (Individual Weight Limit: 20 lbs.) No. of Per Piece Discount E60 1 E61 2 E62 3 E63 4 E64 5 E65 6 E66 7 E67 8 E68 9 E69 10 ECOMPRO No. of Discount E Montreal E Toronto E Vancouver E73 2 E74 3 E75 4 E76 5 E77 6 E78 7 E79 8 E80 9 E81 10 E82 11 E83 12 E84 13 E85 14 E86 15 E87 16 E88 17 ECOMPRO Flat Rate Envelopes (Individual Weight Limit: 4 lbs.) (15" x 9 1/2" or Smaller USPS-Produced) No. of Per Piece Discount E89 1 E90 2 E91 3 E92 4 E93 5 E94 6 E95 7 E96 8 PS Form 3700, January 2018 (Page 12 of 19) Part E continued on next page

13 Priority Mail International Permit Imprint Transmits Customs Data Part E Continued Com Base, Com Plus, GEPS/NSA ECOMPRO Padded Flat Rate Envelopes (Individual Weight Limit: 4 lbs.) E97 1 E98 2 E99 3 E100 4 E101 5 E102 6 E103 7 E104 8 No. of Per Piece Discount ECOMPRO Small Flat Rate Boxes (Individual Weight Limit: 4 lbs.) (Including items O-Small FRBX, ODVDS, and O-1096-L) E105 1 E106 2 E107 3 E108 4 E109 5 E110 6 E111 7 E112 8 No. of Per Piece Discount ECOMPRO Medium Flat Rate Boxes (Individual Weight Limit: 20 lbs.) E113 1 E114 2 E115 3 E116 4 E117 5 E118 6 E119 7 E120 8 No. of Per Piece Discount ECOMPRO Large Flat Rate Boxes (Individual Weight Limit: 20 lbs.) E121 1 E122 2 E123 3 E124 4 E125 5 E126 6 E127 7 E128 8 No. of Per Piece Discount Part E (Add lines E1 E128) PS Form , January 2018 (Page 13 of 19) PSN

14 Priority Mail International Regional Rate Box Transmits Customs Data Part F Box A (Maximum Weight 10 lbs.) F1 1 F2 2 F3 3 F4 4 F5 5 F6 6 F7 7 F8 8 F9 9 F10 10 No. of Discount Box B (Maximum Weight 20 lbs.) No. of Discount F11 1 F12 2 F13 3 F14 4 F15 5 F16 6 F17 7 F18 8 F19 9 F20 10 Part F (Add lines F1 F20) PS Form 3700, January 2018 (Page 14 of 19)

15 Priority Mail Express International Permit Imprint Transmits Customs Data Part G Com Base, Com Plus, GEPS/NSA Priority Mail Express International G1 1 G2 2 G3 3 G4 4 G5 5 G6 6 G7 7 G8 8 G9 9 G10 10 G11 11 G12 12 G13 13 G14 14 G15 15 G16 16 G17 17 No. of Discount Flat Rate Envelope (Individual Weight Limit: 4 lbs.) (12 1/2" x 9 1/2") (EP 13 - F) G18 1 G19 2 G20 3 G21 4 G22 5 G23 6 G24 7 G25 8 No. of Per Piece Discount Padded Flat Rate Envelope (Individual Weight Limit: 4 lbs.) (12 1/2" x 9 1/2") (EP 13 - PE) No. of Per Piece Discount G26 1 G27 2 G28 3 G29 4 G30 5 G31 6 G32 7 G33 8 PS Form , January 2018 (Page 15 of 19) PSN Part G continued on next page

16 Priority Mail Express International Permit Imprint Transmits Customs Data Part G Continued Com Base, Com Plus, GEPS/NSA Legal Flat Rate Envelope (Individual Weight Limit: 4 lbs.) (15" x 9 1/2") (EP 13 - L) No. of Per Piece Discount G34 1 G35 2 G36 3 G37 4 G38 5 G39 6 G40 7 G41 8 Part G (Add lines G1 G41) Global Express Guaranteed (GXG) Permit Imprint Transmits Customs Data Part H Com Base, Com Plus, GEPS/NSA No. of Discount H1 1 (Canada) H2 2 (Mexico) H3 3 H4 4 H5 5 H6 6 H7 7 H8 8 Part H (Add lines H1 H8) PS Form 3700, January 2018 (Page 16 of 19)

17 Commercial epacket Permit Imprint Transmits Customs Data Part P Commercial epacket NSA No. of Piece Discount Piece & P1 1 P2 2 P3 3 P4 4 P5 5 P6 6 P7 7 P8 8 P9 9 P10 10 P11 11 P12 12 P13 13 P14 14 P15 15 Part P (Add lines P1 P15) PS Form , January 2018 (Page 17 of 19) PSN

18 Global Direct Permit Imprint Part Q Global Direct Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14 Destination Country & Product No. of Weight Reserved Part R R1 R2 R3 R4 R5 R6 R7 R8 R9 R10 R11 R12 R13 R14 Destination Country & Product No. of Weight PS Form 3700, January 2018 (Page 18 of 19)

19 International Extra s and s Part S No. of Discount S1 Certificate of Mailing (3 or more Form 3665) S5 Insurance S6 Registered Mail S9 Return Receipt (Form 2865) S17 Picture Permit Imprint S19 Certificate of Bulk Mailing (Form 3606) Part S (Add lines S1 S19) PS Form , January 2018 (Page 19 of 19) PSN

20 International Mail Instructions Use this form for all International Mailings. Step 1: Complete Mailer and Mailing sections on page 1. The Mailer section must be completely filled in, including the Permit Holder in the first box, the Mailing Agent, if any as described below, in the second box, and the Mail Owner, as described below, if other than the Permit Holder, in the third box. Mailing Agent: The mailing agent is a business entity, organization, or individual acting on behalf of one or more mail owners by providing mailing services for which the mail owners compensate the mailing agent. A business entity, organization, or individual whose services define it as a mailing agent may also be considered a mail owner, but only for its own mail or the mail of its subsidiaries. Mailing agents include, but are not limited to the following: Printer, letter shop, address list provider/manager; mail preparer, postage payment provider, mailing logistics provider, mailing tracking provider, ad agency, and mailing information manager. Mail Owner: The mail owner is the business entity, organization, or individual who makes business decisions regarding the mailpiece content, directly benefits from the mailing, and ultimately pays for postage on the mailpiece directly or by way of a mailing agent. Step 2: Determine applicable part(s) A through S to complete for your mailing. Part A: First-Class Mail International (FCMI) including Airmail M-Bags Part B: First-Class Package International (FCPIS) Customs Data Part C: International Surface Air Lift (ISAL) including ISAL M-Bags Part D: International Priority Airmail (IPA) including IPA M-Bags Part E: Priority Mail International (PMI) - Transmits Customs Data Part F: Priority Mail International - Regional Rate Box Part G: Priority Mail Express International (PMEI) - Transmits Customs Data Part H: Global Express Guaranteed (GXG) - Transmits Customs Data Part P: Commercial epacket - Transmits Part Q: Global Direct Part R: Reserved Part S: Extra s and s Step 3: Complete only applicable part(s), enter sum of the (unrounded) postage amounts for that part. Step 4: Return to the section on page 1. Check the boxes that correspond to the form parts used. Add the postage amounts for all parts and enter on Line 1, rounded off to two decimal places. For postage affixed mailings round off to three decimal places. Step 5: Complete Line 2 for Affixed mailings. Check the applicable box (Correct, Lowest, or Neither) for the at which is Affixed. Multiply the number of pieces by the postage affixed. Put the total in the Affixed block. Step 6: Enter any Incentive/Discount Flat Amount on Line 3 and any Flat Dollar Amount on Line 4. Step 7: Calculate Line 5 Net Due by subtracting any Affixed (Line 2) from the (Line 1), subtracting and Incentive/Discount (Line 3), and adding any (Line 4). For permit imprint mailings, the Net Due is the amount that will be withdrawn from the permit imprint account listed in the Permit # box in the Mailing section. For postage affixed mailings, the Net Due is the amount that must be tendered in addition to that already affixed to the mail, and it may be tendered by any of the applicable methods including withdrawal from an advance deposit account that can be listed by Permit # on Line 5. Step 8: Read and sign the Certification section, including your telephone number. Attach all completed pages and submit with the mailing. Postmaster: Report permit imprint revenues using Account Identifier Codes (AIC) as follows: Part A: AIC 243 First-Class Mail International (FCMI) AIC 245 Airmail M-Bags Part B: AIC 243 First-Class Package International (FCPIS) Part C: AIC 234 ISAL (including ISAL M-Bags) Part D: AIC 235 IPA (including IPA M-Bags) Parts E, F, G, & H: AIC 244 Priority Mail International (PMI), PMI Regional Rate Box, Priority Mail Express International (PMEI), and Global Express Guaranteed (GXG) Parts P & Q: AIC 246 Commercial epacket and Global Direct PS Form 3700, January 2018 (Instructions)