End-Use Statement

Template: End-Use Statement – Annex II

Note: Do not send in this template. The text below is to be copied into the end user’s/consignee’s own stationary.

END-USE STATEMENT For items in Annex II Referred to in articles 3a(6), 3c(2) and 3d(2)(b) of Council Regulation (EU) No 267/2012

A. PARTIES Name, address and contact details.

A.1 EXPORTER

......

A.2 CONSIGNEE

......

A.3 END-USER / END-USERS

......

A.4 COUNTRY OF FINAL DESTINATION

......

B. ITEMS

B.1 DETAILED DESCRIPTION OF ITEMS

......

B.2 QUANTITY

...... Units/Weight

Postal address: ISP, SE-164 90 Stockholm, Sweden Visiting adress: Gullfossgatan 6, Kista Phone: 46 8 406 31 00 Fax: 46 8 20 31 00 E-mail: [email protected] Web: www.isp.se 2

B.3 END-USE

...... Specific purpose for which the items will be used. If the items are to be incorporated into or used for the development, production, use or repair of another item, please describe that item, its purpose and its end-user.

B.4 SPECIFICATION OF THE END-USE LOCATION OF THE ITEMS

......

C. STATEMENT OF FOREIGN CONSIGNEE

C.1 CONSIGNEE ACTS AS END-USER

Articles 3a(6) and 3c(2) and point (b) of Article 3d(2) of Council Regulation (EU) No 267/2012 require the applicant for an authorisation to submit this end-use statement or an equivalent document containing information on the end-use and end-use location of any supplied item.

We (I) state that the items described in Section B supplied by the exporter named in Section A.1:

1. will only be used for the purposes described in Section B.3 and that the items or any replica thereof , if applicable, are intended for final use in the country named in Section A.4, in the location specified in Section B.4;

2. that the items or any replica thereof, if applicable:

- will not be used in any nuclear explosive activity or unsafeguarded nuclear fuel-cycle activity; - will not be used for any purpose connected with chemical or biological or nuclear weapons, or missiles capable of delivering such weapons; - will only be used for civil end-uses; - will not be retransferred within Iran without prior information to the exporting State.

SIGNATURE

Signature of end-user/consignee:......

Name of signer in block letters: ......

Position of signer:......

Place and date:......

Stamp/official seal: