END-USER QUALIFICATION

Company: Sadar Mohammad Daud Khan (SMDK) Cust. PO: SEG20005 /LK-GM-
National Military Hospital (NMH) 6000834976

Address: Ahmad Zaher Road Contact: c/o Jon Leigh

Kabul Job Title Regional Sales Mangaer

Afghanistan Tel No: +44 (0) 115 949 1111

Website: None present Email: jon.leigh@eagle-

scientific.co.uk

VAT where N/A

applicable

Main business of the company:

Hospital

State the specific purpose that the goods will be used for:

Testing/maintenance of ECGs

Product lines/families which will be bought:

ProSim8

Product will be used in the following countries (list all that apply):

Afghanistan

True False

1. The customer has confirmed that the product is not intended for a military
application.

2. The customer has been helpful when asked information of the company and
end use of the product.
3. Product capabilities seem reasonable for the buyer’s intended use.
4. Number of products requested seem reasonably when compared to the end-
use.
5. A Fluke employee or authorized Fluke distributor has visited the customer to
confirm the existence of the business.
If false, please state how you have confirmed existence of the business?
This is an international tender available on NATO website. The hospital has
news reports about it on the BBC and other news organisations websites as
well as a Wikipedia page.

6. I have no reason to suspect that this product has an end destination other than
mentioned above.
7. The payment conditions, requested by the customer, do not involve cash and
the delivery dates are clear.
8. The requested place of delivery is not freight forwarder, third party warehouse
or PO Box.
9. The customer is not known or suspected to have relations with embargo
countries.

End User Qualification '20x

 END-USER QUALIFICATION

I confirm that all of the information above is, to my knowledge, true and correct.

Name/ Jon Leigh, Regional Sales Manager

Position:

19/8/2020 Nottingham, UK
Date: Place:

Signature:

ONCE COMPLETE PLEASE EMAIL TO ORDER MANGEMENT.

Any personal data collected through this form will be processed in compliance with the Fluke
privacy policy, which can be found at: https://www.fluke.com/en-gb/fluke/privacy-policy.

End User Qualification '20x