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End Use Declaration - Russia Sanctions v.1.0
End Use Declaration - Russia Sanctions v.1.0
To support Freudenberg’s export controls and compliance requirements, Freudenberg requires that this Export Controls Form be completed
by all our customers where the ultimate end-use/end-user is located in the Russian Federation, or is not known.
Purchase agreements and items will not be provided until the form is accurately completed, signed and returned to your Freudenberg contact.
Thank you very much.
Company/Customer Contact
Name:
Country Location:
Street Address:
Phone Number:
E-Mail Address:
By providing my electronic signature below as an authorized representative of my company, I am verifying that we understand it is our
company’s responsibility to adhere to Export Administration Regulations, Department of Defense, Department of State, Department of
Treasury, and Department of Census regulations related to export transactions. In addition we understand that it is the responsibility of
our company to monitor prohibited end users, embargoed/sanctioned nations lists, and prohibited parties listings for updates that would
affect the course of business and compliance with these government regulations.
Any material omissions, misrepresentations, or misstatements by the customer in connection with the above certifications are grounds
for further action by Freudenberg, including but not Iimited to, cancellation of orders, denial of future business, and appropriate legal
action. Freudenberg may be required by applicable laws, or requested by appropriate law enforcement authorities, to report information
related to, or assist in the investigation of possible violations of U.S. export control laws.
I certify that:
1) I am authorized to sign on behalf of my company, and
2) That the Information provided in this document is true and correct.
Rev.1.0/Sept.2014