Professional Documents
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Annual Euu PC
Annual Euu PC
Copeland Street
Derby DE1 2PU
United Kingdom
T +44(0)1332 349094
F +44(0)1332 371237
www.med‐lab.co.uk
Petrochemical Division
ml‐pc@aerovac.com
Annual Statement of Compliance
A Statement of Compliance is required before we can continue to supply materials to you.
● Please print the attached undertaking on your company letterhead
● A scanned copy is fine as long as it has a customer logo/stamp and signature on it. An original
signed copy does not need to be sent to us
● Signing parties must have signatory authority for their company (preference being given to
someone from Legal or Trade Compliance for that company)
● Language on this document should not be revised. If a customer is unable to sign with the existing
language they should send a redlined copy of their changes for our review and approval
● This Compliance Statement expires 1 year (12 months) after the date of signature
● Compliance Statement must have:
○ Company logo/stamp or letterhead
○ Name and address of the customer
○ date
○ name and title of the empowered official of the company
○ signature of the empowered official
● We accept hand‐writing for the mention of the name of the customer, date, name and title of the
empowered official of the company.
● We accept electronic signature
● Information needs to be in English. Company stamp can be in the customer’s language as long as
the name and address are mentioned in English on the statement.
● This Compliance Statement is valid for all products supplied by Med‐Lab, it should not list any
specific products except when agreed beforehand.
A scanned copy must be returned to Med‐Lab
As soon as we receive the completed undertaking, we will be able to proceed with your enquiry/order.
An Example of a completed document is attached for your assistance.
Statement of End‐Use Compliance
Enter your company name here certifies that all materials ordered by us, from Med‐Lab, are for commercial
end use only. Materials supplied to military end‐users will be used for the testing of fuels only.
We understand that the materials may be controlled for export to certain destinations, end‐uses, and end‐
users. We understand our responsibility to, and agree to, comply with all applicable export control laws
and regulations.
We confirm that the materials will not be used in the design, development, manufacturing, or use in the
following military applications: nuclear, chemical or biological weapons, space and satellite, armoured
vehicles, unmanned aerial vehicle, or the launch or operation of any ballistic missile systems, rocket
systems, sounding rockets, cruise missile systems, or any missile delivery system for weapons of mass
destruction.
These materials will not be re‐exported, diverted or otherwise transferred to Cuba, Iran, North Korea,
Sudan, Syria and any other embargoed countries.
We declare that to the best of our knowledge and belief, the information on this statement is true. We
agree to allow Med‐Lab staff to conduct site visits to verify end use.
This Statement of End‐Use Compliance is valid for one year (12 months) from date of signature.
Company Name
Company Address
Signature ……………………………………………………………….
Name ……………………………………………………………….
Title ……………………………………………………………….
Date ……………………………………………………………….
[Company Stamp/Chop required]