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END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF CHEMICALS

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..... (b) Name of Buyer _________________________________________________________ (c) Buyer s Address _________________________________________________ (d) Name of Consignee_________________________________________________________ (e) Consignee s Address _________________________________________________________ (f) Name of End-User ________________________________________________________ .....

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..... __________________________________________ 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 b .....

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..... 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: .....

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..... 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 .....

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