<p> 1042 Industrial Drive West Berlin, NJ 08091-9164 P: 856-767-7945 F: 856-767-7154 www.trimanindustries.com</p><p>END USER CERTIFICATION</p><p>It is Triman Industries’ policy to verify the end-use and end-users for all sales involving Triman’s items/articles. In order for Triman to ensure compliance with applicable United States export control laws and regulations, including Export Administration Regulations (EAR), International Traffic in Arms Regulations (ITAR), and Office of Foreign Asset Controls (OFAC), as well as other applicable Federal laws and regulations, we require the following information prior to acceptance and shipment of your order. 1. Purchaser PO #: Enter purchasing company’s PO #. 2. Item/Article Info: Part #: Enter part #. NSN #: Enter NSN # if applicable otherwise enter “N/A.” Description: Enter description. Quantity: Enter quantity. 3. End Use Application: Indicate where this is being used (e.g. system on aircraft such as fuel, oxygen, etc.) 4. End Use Platform: Indicate what type of aircraft (model), equipment, program, etc. this is used in. 5. End Use Contract #: Indicate contract # this is being purchased in support of. 6. Purchasing Company: Enter the name of the company purchasing the items/articles from Triman. General type of business: Indicate what purchasing company does, e.g. mfr. aircraft parts, distributor of seals, etc. Street Address (No PO boxes): Enter complete address, no PO boxes. City/Province: Enter city or province. State: Enter state. Postal Code: Enter Postal Code. Country: Enter country. Phone Number: Enter phone number. Responsible Person(s) Name: Enter name of point of contact. Email: Enter email address of responsible person. Reseller: ☐ (note: If purchasing company is a reseller, please proceed to sections 7-9. Please indicate “N/A” within any field that is not applicable.) End User: ☐ (note: If purchasing company is the ultimate end user, indicate “N/A” for sections 7-8 and “same as box 6” for section 9.) 7. Interim Consignee: Enter the name of the company that is receiving the items/articles after you and forwarding to the ultimate consignee/end user. If you are shipping to the end user, enter “N/A” here. Street Address (No PO boxes): Enter complete address, no PO boxes City/Province: Enter city or province. State: Enter state. Postal Code: Enter Postal Code. Country: Enter country. Phone Number: Enter phone number of intermediate consignee. 8. Foreign Consignee: If exporting, please enter the name of the foreign company that will receive the items/articles for forwarding to the ultimate end user. If the ultimate end user is the only foreign consignee and no other foreign company will be receiving the items/articles, enter “N/A.” Street Address (No PO boxes): Enter complete address, no PO boxes. City/Province: Enter city or province. State: Enter state. Postal Code: Enter Postal Code. Country: Enter country. Phone Number: Enter phone number of foreign consignee. 9. Ultimate End User: Enter the name of the company/organization that is the ultimate end user of the items/articles (who will be using it). Street Address (No PO boxes): Enter complete address, no PO boxes. City/Province: Enter city or province. State: Enter state. Postal Code: Enter Postal Code. Country: Enter country. Phone Number: Enter phone number of ultimate end user. Responsible Person(s) Name: Enter name of ultimate end user’s responsible person(s). Email: Enter email address of ultimate end user’s responsible person(s). Page 1 of 2 GM025 VER A-4/17 1042 Industrial Drive West Berlin, NJ 08091-9164 P: 856-767-7945 F: 856-767-7154 www.trimanindustries.com</p><p>END USER STATEMENT</p><p>1. We certify that the items/articles will not be used for purposes associated with nuclear, missile, and chemical and biological weapons or proliferation activities, nor will they be resold if we know or suspect that they are intended or likely to be used for such a purpose. 2. We will not sell, export, re-export, divert or otherwise transfer any of these items/articles, technology or technical data to any entity or country subject to U.S. government approval, including, but not limited to, Cuba, Iran, North Korea, Sudan, Syria unless otherwise authorized by the U.S. Government. 3. We acknowledge that United States law prohibits the sale, export or re-export, diversion or transfer, or other participation in any export transaction involving these items/articles with individuals or companies listed in the U.S. Commerce Department’s Table of Denial Orders, the U.S. Treasury Department’s list of Specially Designated Nationals or the U.S. Department of State’s list of individuals debarred from receiving Munitions List items and other applicable lists, i.e., Entity List. 4. We certify the items/articles on the referenced Purchase Order are for delivery to the end-user stated above. We will abide by all applicable United States and/or destination country export/import control laws and regulations for all items/articles purchased from Triman. Except as specifically authorized by prior written approval of the United States Departments of State or Commerce, Office of Foreign Asset Controls (OFAC), or other applicable Federal Government Agencies, we will not re-export, resell, or otherwise transfer or dispose of these items/articles, technology or technical data outside the country to any person, including the end-user, if there is reason to believe that it will result, directly or indirectly, in disposition of the items/articles contrary to the representations made in this certificate by any party. We further certify that all of the facts contained in this certificate are true and correct to the best of our knowledge and belief. We do not know of any additional facts that are inconsistent with this certification.</p><p>SECTION 10- CERTIFICATION</p><p>Enter name. Enter title.</p><p>Name (printed) Title</p><p>Enter date.</p><p>Signature Date If for foreign end use, enter export license #/authorization (i.e. exception being used, “NLR”) being used to export. Enter company name. </p><p>Company Name Export Authorization</p><p>2</p>