TSA CARGO ACCEPTANCE FORM

Identification Check
Type of Government Issue ID Validity ID Number

Matching Photo on ID? Indicate Yes No

Printed Name of individual (Regulated Agent or Freight Forwarder
repreentative) from whom the cargo was accepted
Company Name (where applicable)

Name of Emirates Staff / GHA who verified ID

Name: ID Number:

Shipper Statement
1 All shipments tendered in this MAWB were received directly from a shipper, or other person with an established relationship
with___________________ (insert name of regulated agent or freight forwarder) for at least 180 calendar days, which has an
established shipping address and a payment, credit or invoice history of at least 180 calendar days OR a person originating or
tendering a shipment where ______________________ (insert name of regulated agent or freight forwarder) has an established
business relationship* or payment, credit or invoice history with the consignee or bill-to party of at least 180 calendar days. All
shipment tendered in this MAWB were accepted via a secure transport, either directly from the shipper, or picked up by
_______________________ (insert name of regulated agent or freight forwarder) or agent.

*An established business relationship is an association between persons ("persons" includes individuals and entities) that may
also include a documented history of sales contacts or activities, other documented correspondence or business records.
2 The US Government has required Emirates to inspect your cargo to verify its contents prior transportation by air. Your cargo will
be subject to security controls.
Shipper authorizes consent to screen, search and inspect this shipment tendered by Shipper/Agent

3 _______________________ (name of person or entity tendering cargo shipment) has reviewed all available documentation and
has determined that none of the cargo being offered in this consignment or consolidation has originated in, transferred from, or
transited through any point in Egypt, Somalia, Syria, or Yemen

Additional Security Information :

(if no 1 is not applicable, shipment must be screened under enhanced security requirement TSA IV.3.2.1)

Signature of Regulated Agent or Freight Forwarder representative : Date - Time :

Note:
- This form must be completed by direct employees and/or carrier representatives only
- Copy of the valid ID must be attached with this form
- One copy must be retained at the origin station for 90 days
- One copy must accompany the shipment
- Only valid ID issued by government authority
- Unauthorized disclosure of ID information is strictly prohibited
- If any information required is not available, shipment must be rejected