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It collects applicant identification details, licensing and employment status, prior applications for a customs broker license, and any history of arrest or criminal violations. The form also requests bankruptcy or tax lien disclosures, proposed business engagement information, and six reference contacts. Sections include organization details and officer or principal listings, followed by certification and signature and date fields.","See back of form for Paperwork Reduction Act Notice.  \n\n| 1.APPLICANT'S NAME AND ADDRESS (Principal Office)  \u003Cbr>(Indicate fictitious name,if applicable)   |\n| --- |\n|  |\n\nINSTRUCTIONS:Applicants must be United States citizens.Pursuant to the requirements of 19CFR 11112(b)the information contained in Blocks  \n1,2,3,22 and 23 may be released to the public and posted by appropriate electronic means.Submi application in duplicate to the Port Director of thePort name in Block 3.All additional continuation sheets,if required,and attachments should be in duplicate                       \n2.TYPE OF LICENSE APPLIED FOR  \nPartnership  \nAssociation  \nCorporation  \nIndividual  \n3.CBP PORT  \n4.HAVE YOU EVER APPLIED FOR A CUSTOMS BROKER'S LICENSE?  \nNO  \nYES (Explain in Block 18)  \n5.HAS THE APPLICANT(OR ANY OFFICER,MEMBER,OR PRINCIPAL|6.IS THE APPLICANT (OR ANY OFFICER,MEMBER OR PRINCIPAL THEREOF  \nAS IDENTIFIED IN BLOCK 22)AN OFFICER OR EMPLOYEE OF THE  \nTHERE OF AS IDENTIFIED IN BLOCK 22)EVER HADALICENSE  \nUNITED STATES?  \nSUSPENDED,REFUSED,REVOKED,OR CANCELLED?  \nNO  \n□NO  \nYES (Explain in Block 18)  \nYES (Explain in Block 18)  \nSECTIONI-INDIVIDUALS ONLY  \n9.SOCIAL SECURITY NO.  \n11.BUSINESS PHONE NO.  \n10.HOME PHONE NO.  \n8.BIRTHPLACE(City&State)  \n7.DATE OF BIRTH  \n12.U.S.CITIZENSHIP  \nNATURALIZED:Give Date and Place  \nNATURAL-BORN  \n\n| 13.HAVE YOU EVER BEEN ARRESTED,CHARGED,CONVICTED OF OR  \u003Cbr>FORFEITED COLLATERAL FOR,ANY FELONY,MISDEMEANOR,OR  \u003Cbr>OTHER VIOLATION?  \u003Cbr>(You may omit:1.traffic violations for which you paid a fine of $250or less;2.any  \u003Cbr>incident which happened before your 16th birthday.All other incidents must be  \u003Cbr>included,even though the case records were expunged or suppressed under a  \u003Cbr>rehabilitation program,oryou were sentenced undera State statute which provides that  \u003Cbr>you need not report the incident when applying foremployment,a license,etc.)  \u003Cbr>□NO  \u003Cbr>YES (Explain in Block 18)   | 14.RESIDENCE ADDRESS (If different from Block 1;if same,write \"SAME\"   |\n| --- | --- |\n|  |  |\n\n15.IN THE LAST5YEARS,HAVE YOU,OR A COMPANY OVER WHICH YOU EXCERCISED SOME CONTROL,FILED FOR BANKRUPTCY,BEENDECLARED BANKRUPT,BEEN SUBJECT TO A TAX LIEN,OR HAD LEGAL JUDGEMENT RENDERED AGAINST YOU FOR A DEBT?YES(Explain in Block 18)  \n16.DO YOU PROPOSE TO ENGAGE IN THE BUSINESS OFACUSTOMS BROKER:(More than one may apply.Explain answers in Block 18.)ON YOUR OWN INDIVIDUALACCOUNT?(State name in which business is to be conducted;i trade name,state authority for useof the name and attach evidence of such authority.)  \n(b)□AS A MEMBER OF APARTNERSHIP?(State name of partnership and list names ofall the partners.)  \n(c)□AS AN OFFICER OF AN ASSOCIATION?(State name of the association,the title of the office you hold,and the general nature of your duties.)  \n(d)□AS AN OFFICER OF A CORPORATION?(State name of the corporation,the title of the office you hold,andthe general nature of your duties.)  \n(e)□ASAN EMPLOYEE?(State name and address of your employer i difrent from Block 1;write \"SAME\"and the nature of your employment)  \n17.LIST THE NAMES,ADDRESSES,AND PHONE NUMBERS OF SIX REFERENCES  \n\n|  |  |  |\n| --- | --- | --- |\n|  |  |  |\n\n18.REMARKS (In responding to questions above,include Block no.If more space is needed continue on blank sheet of paper.)  \nSECTIONⅡ--FOR ASSOCIATION,CORPORATION,OR PARTNERSHIP ONLY  \n\n| 19.DATE APPLICANT WAS ORGANIZED   | 20.STATE WHERE ORGANIZED   | 21.ATTACHMENTS  \u003Cbr>Evidence of the partnership(copy of the articles  \u003Cbr>Copy of articles of  \u003Cbr>of agreement or affidavit signed by allpartners)  \u003Cbr>incorporation or association   |\n| --- | --- | --- |\n\n22.LIST THE NAMES,ADDRESSES,TITLES,AND DATES AND PLACES OF BIRTH OF ALL OFFICERS OF THE ASSOCIATION OR CORPORATION,ANDALL PRINCIPALS WHO HAVE A CONTROLLING INTEREST (Example:10%or more of stock),WHOHOLD INDIVIDUAL CUSTOMS BROKERS'LICENSES AND GIVE THE GENERAL NATURE OF DUTIES OF EACH,OR IFA PARTNERSHIP,LIST NAMEAND ADDRESS OF MEMBERS WHOHOLD SUCH LICENSES.","cbCaiolbJ5Yr48AM","https://ap.wps.com/l/cbCaiolbJ5Yr48AM","pdf",639682,14,"English","en",105,"# Applicant Identification\n## License Information and History\n# Individual Section\n## Personal Details and Addresses\n## Criminal and Legal Disclosures\n## Business Plans and References\n# Organization Section\n## Organization Dates and Attachments\n## Officers, Principals, and Controlling Interests\n# Certification\n## Signature and Date","[{\"question\":\"What information does CBP Form 3124 request about the applicant?\",\"answer\":\"It requests the applicant’s name and address, birth details, phone numbers, citizenship status, residence address, and identification information, along with business phone and other contact details.\"},{\"question\":\"Does the form ask about prior customs broker license applications and disciplinary history?\",\"answer\":\"Yes. It asks whether the applicant has previously applied for a customs broker’s license and whether any license has ever been suspended, refused, revoked, or cancelled.\"},{\"question\":\"What are the certification and signature requirements?\",\"answer\":\"The form includes a certification section where all applicants attest that statements and supporting attachments are true and correct, followed by signature and date fields for the applicant or authorized officers/partners.\"}]","CBP Form 3124 - Customs Broker License Application | PDF",1790423645,{"code":4,"msg":81,"data":82},"ok",{"site_id":75,"language":74,"slug":83,"title":65,"keywords":84,"description":66,"schema_data":85,"social_meta":139,"head_meta":141,"extra_data":143,"updated_unix":144},"cbp-form-3124-customs-broker-license-application","",{"@graph":86,"@context":138},[87,101,121],{"@type":88,"itemListElement":89},"BreadcrumbList",[90,94,96,99],{"item":91,"name":92,"@type":93,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":95,"name":9,"@type":93,"position":14},"https://docshare.wps.com/document/",{"item":97,"name":20,"@type":93,"position":98},"https://docshare.wps.com/document/exam/",3,{"item":100,"name":65,"@type":93,"position":19},"https://docshare.wps.com/document/cbp-form-3124-customs-broker-license-application/395770/",{"url":100,"name":65,"@type":102,"image":103,"author":108,"headline":65,"publisher":110,"fileFormat":113,"inLanguage":74,"description":66,"dateModified":114,"datePublished":115,"encodingFormat":113,"isAccessibleForFree":116,"interactionStatistic":117},"DigitalDocument",{"url":104,"@type":105,"width":106,"height":107},"https://docshare.wps.com/thumbnails/cbp-form-3124-customs-broker-license-application/395770.png","ImageObject",300,407,{"name":63,"@type":109},"Person",{"url":91,"name":111,"@type":112},"DocShare","Organization","application/pdf","2026-11-10","2026-09-26",true,{"@type":118,"interactionType":119,"userInteractionCount":72},"InteractionCounter",{"@type":120},"ViewAction",{"@type":122,"mainEntity":123},"FAQPage",[124,130,134],{"name":125,"@type":126,"acceptedAnswer":127},"What information does CBP Form 3124 request about the applicant?","Question",{"text":128,"@type":129},"It requests the applicant’s name and address, birth details, phone numbers, citizenship status, residence address, and identification information, along with business phone and other contact details.","Answer",{"name":131,"@type":126,"acceptedAnswer":132},"Does the form ask about prior customs broker license applications and disciplinary history?",{"text":133,"@type":129},"Yes. It asks whether the applicant has previously applied for a customs broker’s license and whether any license has ever been suspended, refused, revoked, or cancelled.",{"name":135,"@type":126,"acceptedAnswer":136},"What are the certification and signature requirements?",{"text":137,"@type":129},"The form includes a certification section where all applicants attest that statements and supporting attachments are true and correct, followed by signature and date fields for the applicant or authorized officers/partners.","https://schema.org",{"og:url":100,"og:type":140,"og:title":65,"og:site_name":111,"og:description":66},"article",{"robots":142,"canonical":100},"index,follow",{"doc_id":61,"site_id":75},1790627257]