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

1 [APPENDIX- 2 S (ii) END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF CHEMICALS 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 (a) Description of the item(s) (e.g. Purity/Concentration, IUPAC Name CAS number (b) Quantity/Weight (c) Purchase order Number Date of signature of contract ________________________________________________ PART 3: DECLARATION a) The item(s) indicated in PART 2 will be used for _______________________________________________________________________ b) 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. c) 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. d) 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 and that the chemical(s) will only be used for purposes not prohibited under the Chemical Weapons Convention (CWC). e) 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: ________________________________ Telephone number: _________________________ ____________________________________________ Email: ____________________________ PART 4 CERTIFICATION ON BEHALF OF THE RECEPIENT STATE 1 As an authorised signatory for the government of the recipient state, I confirm that the chemical(s) described in Part 2, will be used by the entity named at 1(f) and that the chemical(s) will only be used for purposes not prohibited under the Chemical Weapons Convention (CWC) and the chemical(s) shall not be transferred to any other person or re-exported from the recipient country. Signature _________________________ Date _________________ (signature of official government representative) Name: _____________________________ Government department/ministry stamp Designation ____________________________ Organization Contact details: __________________________________________________ [To be submitted, for export of items in Category 1 of SCOMET list, by all entities in the chain of supply on the letterhead of the respective entity. Any additional sheets must be signed by the same person who signs this form. 1: To be filled for transfers of SCOMET Category 1C Chemicals to states not party to the Chemical Weapons Convention ] ------------------------- Notes:- 1. Inserted vide Public Notice No. 4/2015-20, dated 24-04-2017