UnitedStatesPostalService

ApplicationforDeliveryofMailThroughAgent
SeePrivacyActStatementonReverse

1.
Date 1/8/2015

(mm/dd/yyyy)

Inconsideration of delivery of my or our (firm) mail to the agent named below, the addressee and agent agree: (1) the addressee or the agent must not file a change of
addressorderwiththePostalServiceuponterminationoftheagencyrelationship(2)thetransferofmailtoanotheraddressistheresponsibilityoftheaddresseeandthe
agent(3)allmaildeliveredtotheagencyunderthisauthorizationmustbeprepaidwithnewpostagewhenredepositedinthemails(4)uponrequesttheagentmustprovide
tothePostalServicealladdressestowhichtheagencytransfersmailand(5)whenanyinformationrequiredonthisformchangesorbecomesobsolete,theaddressee(s)
mustfilearevisedapplicationwiththeCommercialMailReceivingAgency(CMRA).
NOTE:The applicant must execute this form in duplicate in the presence of the agent, his or her authorized employee, or a notary public. The agent provides the original
completedsignedPSForm1583tothePostalServiceandretainsaduplicatecompletedsignedcopyattheCMRAbusinesslocation.TheCMRAcopyofPSFormPS1583
must at all times be available for examination by the postmaster (or designee) and the Postal Inspection Service. The addressee and the agent agree to comply with all
applicablePostalServicerulesandregulationsrelativetodeliveryofmailthroughanagent.Failuretocomplywillsubjecttheagencytowithholdingofmailfromdeliveryuntil
correctiveactionistaken.
ThisapplicationmaybesubjecttoverificationproceduresbythePostalServicetoconfirmthattheapplicantresidesorconductsbusinessatthehomeorbusinessaddress
listedinboxes7or10,andthattheidentificationlistedinbox8isvalid.

2.NameinWhichApplicant'sMailWillBeReceivedforDeliverytoAgent.
3a.AddresstoBeUsedforDelivery(IncludePMBor#sign.)
(CompleteaseparateForm1583forEACHapplicant.Spousesmay
#PTY 99879
completeandsignoneForm1583.Twoitemsofvalididentificationapplyto
thSt./P.O.BOX25207
7801NW37
eachspouse.Includedissimilarinformationforeitherspouseinappropriate
3b.City
3c.State
3d.ZIP+4
box.)

AirboxExpress,S.A.(PANAMA)

4.Applicantauthorizesdeliverytoandincareof:
a.Name

AirboxExpress,S.A.(PANAMA)
b.Address(No.,street,apt./ste.no.)

7801NW37thSt./P.O.BOX25207
c.City

d.State

e.Zip+4

DORAL

FL

331666503

DORAL

FL

331666503

5.Thisauthorizationisextendedtoincluderestricteddeliverymailforthe
undersigned(s):
1.JuanArvalo

2.
3.
4.

6.NameofApplicant
JuanArvalo

7a.ApplicantHomeAddress(No.,street,apt./ste.no)
VaBrasil,edif.moniti,Apartamento1E
7b.City
7c.State
8.Twotypesofidentificationarerequired.Onemustcontainaphotograph
Panama
Panam
oftheaddressee(s).SocialSecuritycards,creditcards,andbirth
7e.ApplicantTelephoneNumber(Includeareacode)
certificatesareunacceptableasidentification.Theagentmustwritein
identifyinginformation.Subjecttoverification.
(
)60306183
9.NameofFirmorCorporation

a.
Pasaporte

10a.BusinessAddress(No.,street,apt./ste.no)

7d.ZIP+4

(035947585

b.

10b.City

10c.State

10d.ZIP+4

10e.BusinessTelephoneNumber(Includeareacode)

(3966109)
Acceptableidentificationincludes:validdriver'slicenseorstatenondriver's 11.TypeofBusiness
identificationcardarmedforces,government,university,orrecognized
corporateidentificationcardpassport,alienregistrationcardorcertificate
ofnaturalizationcurrentlease,mortgageorDeedofTrustvoteror
vehicleregistrationcardorahomeorvehicleinsurancepolicy.A
photocopyofyouridentificationmayberetainedbyagentforverification.

12.IfApplicantIsaFirm,NameEachMemberWhoseMailIstoBeDelivered.(Allnameslistedmusthaveverifiableidentification.Aguardianmustlistthe
namesandagesofminorsreceivingmailattheirdeliveryaddress.)
13.IfaCORPORATION,GiveNamesandAddressesofItsOfficers

14.IfBusinessNameofTheAddress(CorporationorTradeName)Has
BeenRegistered,GiveNameofCountyandState,andDateofRegistration.

Warning:Thefurnishingoffalseormisleadinginformationonthisformoromissionofmaterialinformationmayresultincriminalsanctions(includingfines
andimprisonment)and/orcivilsanctions(includingmultipledamagesandcivilpenalties).
15.SignatureofAgent/NotaryPublic
16.SignatureofApplicant(Iffirmorcorporation,applicationmustbesigned
byofficer.Showtitle.)

PSForm1583,December2004(7530010009365)

SIGNHERE/FIRMEAQUI: