A F F I D A V I T

CARIBE EXPRESS

6505 Hudson Ave. West New York . NJ . 07093

                    Person traveling to Cuba in one 12 month period for reasons of humanitarian need

                        Date of declaration:                                , I                                                             

                        declare the following:

                        1.- I understand that under a general license (515.561), there is a possibility to 

                        travel once in any 12-month period to visit close relatives in Cuba in circumstances

                        that demonstrate humanitarian  need.

                        2.- I understand that if I need to travel to Cuba for a second time within the 12

                        month period I must apply in writing for a specific license from the Office of Foreign

                        Assets Control before engaging any travel related transaction.

                        I have read and understood the above mentioned and certify that:

                        I have not traveled to Cuba within a period of 12 months under the terms of

                        the humanitarian need general license

                        I certified that above information is true and correct.

                        SIGNATURE                                                        /                                     DATE

                        Witnessed by employee of  TSP or CSP.

                        Name [print]____________________________  Signature_________________

      Caribe Express     

Service Provider's name

 For use only in Caribe Express