7751 W.

88th Street, Bridgeview, IL 60455

Tel 708-599-9680, Fax 708-599-9682
E-mail: INFO@atlanticexpresscorp.com

End User Declaration

1. SHIPPER - Billing Party (Self)
Company name
Company type Private
Contact name * EDREES KHALFAN MOHAMMED AL NAHDI
Address * SAMAEL , AL MAZRA'A AREA , WAY 15, AL DAKHILIYA, Oman, 620
Phone * +96896003099
Email * edreesalnahdi89@gmail.com
Identification type Foreign Passport No
SHIPPER EIN or TAX ID or FOREIGN PASSPORT NUMBER# (required)
PM6676073
2. CONSIGNEE (RECEIVER):
Company name EDREES KHALFAN MOHAMMED AL NAHDI
Company type Private
Contact name * EDREES KHALFAN MOHAMMED AL NAHDI
Address * SAMAEL , AL MAZRA'A AREA , WAY 15, AL DAKHILIYA, Oman, 620
Phone * +96896003099
Email * edreesalnahdi89@gmail.com
Identification type Foreign Passport No

3. END USE:
Personal use

Resale/Wholesale for Business related use

4. FOREIGN END-USER:
The non U.S. entity that receives and ultimately uses the exported or re-exported item, even after being
incorporated into a higher level assembly. The end-user is not a forwarding agent or intermediary, but may be the
purchaser or the ultimate consignee.

END USER DETAILS

Name EDREES KHALFAN MOHAMMED AL NAHDI
Address SAMAEL , AL MAZRA'A AREA , WAY 15, AL DAKHILIYA, Oman, 620
City AL DAKHILIYA
Country Oman

I, the undersigned, hereby certify that all of the representations made herein are true and correct, and that the
above-mentioned commodity(s) are for the stated end-use and end-user, to the best of my knowledge and belief.

Date: 02/28/2023 Signature: DocuSignPlace1