REPUBLIC OF XXXXXXXXXX

XXXXXXXXXX
Adress: XXXXXXXXXX

N° XXXXXXXXX / Date: XXX

END USER CERTIFICATE

To the XXXXXXXXXX (Manufacturer or Seller)

…………………………………(Manufacturer/Seller Adress)

1. Name of the End User and Address: XXXXXXXXXX

2. Name of Exported and Address: XXXXXXXXXX

3. Name of Importer and Address: XXXXXXXXXX (if required)

4. Denomination and full description of the goods

No Description Quantity
1 XXXXXXXXXX XXXXpcs

5. Certification of the Foreign END-USER:

We certify that we are the end-user for the goods listed article 4 and that we intend to use
them for the following purpose:

……………………………………………………….

We undertake not to sell, lend or deliver to any party, under any conditions whatsoever,
with or without compensation, temporary or permanently the goods listed in article 4,
including the equipment and spare parts delivered in connection with after-sales support,
documentation and operating manuals, without the prior written approval of exporter.

6. Certification of the END-USER Governmental Authority:

We undertake that the goods listed in article 4 will not sell, lend, supply or deliver to any
party, to all non- government entities and individuals, all territory of XXXXXXXXXX

7. We certify that we are fully authorized to compose the End User Certificate.