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CERTIFICATE OF END-USE ASSURANCE FOR DUAL-USE ITEMS AND TECHNOLOGY

TO BE ISSUED ON COMPANY LETTER HEADED PAPER

1. Exporter

Name:

Address:

2. Consignee

Name:

Address:

3. End-User (if different to consignee)

Name:

Address:

4. Goods

(a) Detailed description of goods

(b) Quantity

(c) Value (€)

5. End-Use

Specific purpose for which the goods will be used

6. Undertaking

We certify that: -

We are the end-user of the goods described in Section 3, which are to be supplied by the exporter named in Section 1;

We further certify that we shall use the goods for the purposes described in Section 5;

The goods will not be used for any purpose connected with chemical, biological or nuclear weapons, or missiles capable of delivering such weapons;

The goods will not be re-exported or otherwise re-sold or transferred if it is known or suspected that they are intended or likely to be used for such purposes;

The goods will not be diverted to another destination; and,

In the event of the goods being so re-exported, the export will be conducted in accordance with the regulations of the national licensing authority in ......... [insert name of country].

Signed:___________________________ Name in block letters_____________________

Position in end-user company:______________________________

Date:______________ Company Stamp/official seal

Last modified: 28/08/2002

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