Appendix -2S(i) - END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF SCOMET ITEMS - Foreign Trade Procedure 2015-2020 (From 5-12-2017 to 31-3-2023) Revised

1 [APPENDIX- 2S (i) END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF SCOMET ITEMS PART 1: PARTIES CONCERNED (a) Name of Exporter________________________________________________ (b) Name of Buyer ________________________________________________ (c) Buyer s Address ________________________________________________ (d) Name of Consignee ________________________________________________ (e) Consignee s Address ________________________________________________ (f) Name of End-User ________________________________________________ (g) End-User s Address ________________________________________________ (h) Specific Location where the items will be used (if different from (g))__________________________________________ PART 2: ITEMS (goods, software, technology) (a) Description of the item(s) (e.g. Name of Model, Class, Type, Serial Number) (b) Quantity/Weight /Value 1 (c) Purchase order Number Date of signature of contract___________________________________________________ PART 3: DECLARATION a) The item(s) indicated in PART 2 will be used as capital equipment/ component / raw material / other use for_______________________________ b) The item(s) indicated in PART 2 are being processed or incorporated into another product 2 (as detailed in 3a above), for sale to ultimate end users located in _________________________ c) I/we certify that the above-mentioned items (as detailed in the referenced purchase order) shall not be used for any purpose other than the purpose(s) stated above and that such use shall not be changed nor the items modified or replicated without the prior consent of the Government of India. Post shipment verification shall be allowed if required by the Government of India, as may be applicable. In case the above-mentioned item(s) include(s) technology, we certify that it will be treated as strictly confidential. d) The end-user shall not himself, or through another, cause the items, or replicas, or derivatives thereof to be re-transferred / sold without the consent of the Government of India, to any party within (country of final destination) __________________________ or outside it unless specifically exempted in the export authorization. e) I/We also certify that the above items imported by us shall not be used to develop, acquire, manufacture, possess, transport, transfer or use, chemical, biological, nuclear weapons or for missiles capable of delivering such weapons. f) I/we also certify that all the facts contained in this certificate are true and correct to the best of my knowledge and belief and that I/we do not know of any additional facts that are inconsistent with this certificate. Signature: _____________________________ Date: ________________ (Signature of authorised signatory) Name: _____________________________________________ Designation: ______________ Address: ____________________________________________ ____________________________________________ Email: ____________________________________________ Telephone number: _______________________________________ [To be submitted by all entities in the chain of supply on the letterhead of the respective entity. Any additional pages must be signed by the same person who signs this form. For Category 1 items, use Appendix 2S(ii) 1: For Technology exports, value should be mentioned in Part 2(b) 2: Cross this line if it is not applicable] ] ------------------- Notes:- 1. Substituted vide Public Notice No. 4/2015-20, dated 24-04-2017 , before it was read as:- APPENDIX- 2 S END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF SCOMET ITEMS [TO BE SUBMITTED BY ALL ENTITIES IN THE CHAIN OF SUPPLY VIZ. THE FOREIGN BUYER, THE END USER INTERMEDIARIES/CONSIGNEE (IF THEY ARE DIFFERENT FROM THE FOREIGN BUYER AND END USER). THIS CERTIFICATE SHALL BE ISSUED ON THE LETTERHEADS OF RESPECTIVE ENTITY] I /We (name)________________________________________________________(name address of the foreign buyer/end user/intermediary(ies)/consignee(s) certify that we are importing (name of the SCOMET item)____________________________ from (name and address of the exporter)_________________________________________/ through______________________________(name address of the intermediary/consignee) against Purchase Order No/Contract No.________________ dated__________ as capital equipment/ component / raw material / other use (specify)_______________________________________ for the manufacture of (end product)____________________________which will be used for (state specific use)*____________________________________________________________. (* if more than one use then enclose self certified list) I/we further certify that the items detailed in the referenced purchase order shall not be used for any purpose other than the purpose (s) stated above and that such use shall not be changed nor the items modified or replicated without the prior consent of the Government of India. And further, if required, post installation verification shall be allowed. The end-user shall not himself, or through another, cause the items, or replicas, or derivatives thereof to be re-transferred / sold without the consent of the Government of India, to any party within (name of the country)___________________________________ or outside it. I/We also certify that the above items imported by us shall not be used for any purpose that relate to the development of Weapons of Mass Destruction. I/we also certify that all the facts contained in this certificate are true and correct to the best of my knowledge and belief and that I/we do not know of any additional facts that are inconsistent with this certificate. Place: Date: Seal Signature of end-user / authorised signatory of the end-user with stamp and seal Name:____________________________ Designation:_______________________ Address :_________________________ Tel. (STD Code)-___________________ E-mail:___________________________ CERTIFICATION ON BEHALF OF THE RECEPIENT STATE (For Schedule 3 Chemicals of CWC, viz. Category 1 C of SCOMET list) (To be filled for transfers of Schedule 3 Chemicals to states not party to the Convention) It is hereby certified that the transferred Chemical referred to above shall be used only for purposes not prohibited / disallowed under the Chemical Weapons Convention and shall not be transferred to any other person or re-exported from the recipient country. Name of the chemical (IUPAC nomenclature) Quantity Seal Signature:_________________________ Name:____________________________ Position:__________________________ Organisation / State:_________________ Address:__________________________ Tel. (STD Code)-___________________ E-mail:___________________________