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(Letter head or company stamp of the end customer) (City, date)

OERLIKON LEYBOLD VACUUM GmbH


Dept. ...........
Address
Country

(if required fax number)

END USER DECLARATION

We herewith confirm, that the goods / services (in the case of more than two items, please
describe only the principal
components): ..................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.......................
.........................................................................................................................................................
(please expand the description as required, or use a separate sheet)

enquired about / ordered through enquiry No. ...................... /order / Contract


No............................ dated ...........................200....... will be used by us exclusively for the
following process / application (please give an accurate and detailed description; general
statements like laboratory use will not be accepted):
.............................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
............

(please expand the description as required, or use a separate sheet)

Furthermore we herewith confirm that the goods enquired about / ordered / or the services will
not be used in the manufacture, modernisation, maintenance or the proliferation of nuclear,
biological or chemical weapons or carrier systems suited for these.

(Legally binding signature of a fully authorised person)

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