Appendix-10J(iv) - End Use Cum End User Certificate in Case of Global Authorization For Intra Company Transfer (GAICT) - Foreign Trade - Handbook of Procedures, 2023

Appendix-10J(iv) (Please see Paragraph 10.15 of HBP) End Use Cum End User Certificate in Case of Global Authorization For Intra Company Transfer (GAICT) PART 1: PARTIES CONCERNED (a) Name of Exporter (b) Name of Consignee (c) Consignee s Address (d) Zip code______________Tele No __________________Email_______________Fax__________ (e) Nature of usual business of the consignee (e.g., distributor, manufacturer etc.)____________________ (f) Name ofEnd-User__________________________________________________________________ (g) End-User s Address Zip code______________ Tele No. ________________Email________________Fax____________ (h) Specific Location where the items will be used (if different from(g)) (i) Nature of usual business of the End-User (e.g. manufacturer or research) _____________________ (j) Business relationship with the applicant exporter (Parent company/subsidiaries) ________________________________________________________ (k) How long has your business relationship with the applicant exporter existed? ______________________ (l) Intermediary (if any) _________________________ (m) Intermediary s Address_______________________________ PART 2: ITEMS (goods, software, technology) Sl.No. (a) Description of the item(s) (e.g. Name of Manufacturer/Model/Software/Technology, Class, Type, Serial Number) (b) Quantity/Weight /Value 1 (c) Master Service Agreement / Contract Agreement Number Date of signature PART 3: DECLARATION a) The item(s) indicated in PART2 will be used as capital equipment/component/raw material /other use for (Intended End use) b) The item(s) indicated in PART2 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/ master service agreement/other contract agreement) 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. In case the above-mentioned item(s) include(s) technology- we certify that it will be treated as strictly confidential. d) I/we certify that the items/software/technology indicated in part 2 is/are to be re-exported as per the terms and condition of Global Authorization for Intra Company Transfer (GAICT) policy of the Government of India and shall be allowed only to the entities eligible under authorization for GAICT. e) I/we certify that I/we will provide DGFT, Government of India with delivery verification upon its request. f) Post shipment verification of the items at the end users site shall be allowed, if required by the Government of India, as may be applicable. g) I/we shall not myself/ourself, or through another, cause the items, or replicas, or derivatives thereof to be re-exported/ re-transferred/sold without the consent of the licensing authority of the country of the end user, to any party within country of final destination or outside it, unless specifically exempted in the export authorization. h) I/We also certify that the above items and/or replicas thereof will not be used to design, develop, acquire, manufacture, possess, transport, transfer and/or used for chemical, biological, nuclear weapons or for missiles capable of delivering weapons of mass destruction and their delivery system. The items will be used for civil purposes only. i) I/We also certify that I/we are not a party designated under UNSC sanctioned individual/entities/groups and I/we are neither owned nor controlled by a designated party under UNSC individual/entities/groups. j) 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: (Signature of authorized signatory) Company stamp/Official seal__________________________ Name: Designation Date: Address:_______________________ Email: Alternate Email: Tele No.: [To be submitted by foreign parent company on its letterhead indicating full chain of supply in case of other subsidiaries are also involved. Any additional page(s) must be signed by the same person who signs this form. 1: For Technology exports, value should be mentioned in Part 2(b) 2: Cross this line if it is not applicable]