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.
 

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.
 

Note : [Please read carefully]

1. The word 'items' imply goods, software, technology
2. For Technology exports, value should be mentioned in Part 2
3. Please indicate full details of end use under declaration in Part 3(a)
4. Strike out, if any entry is not applicable
5. Any additional sheet must be on the letterhead of the company and signed by the same person who signs this form
6. For SCOMET Category 1 items, EUC proforma Appendix 25(ii) and for Stock & Sale proforma Appendix 2S(iii) will apply

PART 1: DETAILS OF THE ENTITIES

(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 (goods, software, technology)-twill be finally used (if different from (g)) *
*Remarks: The items will be installed at the premises of the end-user or will be used only by the end-user.

PART 2: ITEMS (goods, software, technology)
 

PART 3: DECLARATION

a) The item(s) indicated in PART 2 will be used as capital equipment/ component / raw material / other³ _____________ (select one) for use as (indicate full details of end use): ___________________

b) The item(s) indicated in PART 2 are being processed or incorporated into another product (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.

d) The items are for end-use of bona-fide customers in one or more of the following countries, either in their current state or after incorporation and the items will not be re-exported or sold for export without following the export control regulations of the said country of end-use: ________________________________________ (names of countries);

¹ For definition of software and technology refer to the glossary of SCOMET Appendix-III. Also refer to the general technology note and general software note and the general information security note of SCOMET Appendix-III

² For Technology exports, value should be mentioned (if applicable) in Part 2

³ Please indicate the use

e) Post shipment verification of the items at end users site 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;

f) The end-user shall not himself, or through another, cause the items, or replicas, or derivatives thereof to be re-exported / transshipped/ 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/policy.

g) The items listed at Part 2 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 if it is known or suspected that they are intended or likely to be used for such purposes.

h) It is also certified 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.

PART 4: SPECIFIC DETAILS OF AUTHORIZED SIGNATORY (mandatory):

a. Name (in capital letters only): _________________________________

b. Designation: _______________________

c. Complete office address (with room No. area, city, district, state, country) : ___________________

d. Pin/Zip/Postal Code : _________________________

e. Telephone number (with ISD code): _______________________ or

f. Mobile No. : ___________________ Alternate mobile number (if any): __________________

g. Fax No with ISD Code. : _______________ (if any)

h. Primary Email: ___________________ Alternate email: ___________________

Specific details of alternate contact person authorized for the purpose (optional):

Same as (a) to (h) above

Signature (authorised signatory): _________________________________

Official seal / stamp:

Date of issue:

Validity date (specify the period, if any):

Explanatory note for export of software and technology:

1. For export of software and technology in Part 2, a letter of explanation detailing the following be provided alongwith FUC (letter to be signed by the same person who signs the EUC):

■ The exact project location where the technology will be used;

■ The type of technology to be exported or re-exported;'

■ The technology value addition such as upgrade/update, support, specific customisation of software

■ The form in which the export or re-export will be made;

■ The uses for which the data will be employed.

2. If the technology value addition is carried out by the Indian exporter, then the following additional details are required to be provided by the Indian exporter on its letter head alongwith application:

An explanation of the process, product, specification (catalogue), size and output capacity of all items to be produced with the technology, if applicable, or other description that delineates, defines, and limits the data to be transmitted (the "technical scope"); and the availability abroad of comparable foreign technology.
 

Note : [Please read carefully]

1. The word 'items' imply chemicals and related software and technology

2. Please indicate Purity/Concentration, IUPAC Name, CAS number & ITC(HS) code in Part 2(a)

3. Please indicate full details of end use under declaration in Part 3(a)

4. Strike out, if any entry is not applicable 5. Any additional sheet must be on the letterhead of the company and signed by the same person who signs this form

6. For SCOMET Categories, other than Category 1, EUC proforma Appendix 25(i) and for Stock & Sale proforma Appendix 2S(iii) will apply

PART 1: DETAILS OF THE ENTITIES

(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 (goods, software, technology)' will be finally used (if different from (g)) *

*Remarks: The items will be installed at the premises of the end-user or will be used only by the end-user.

PART 2: ITEMS (goods, software, technology)
 

PART 3: DECLARATION

a) The item(s) indicated in PART 2 will be used :

(i) as a raw material for manufacture of __________________________ which will be ultimately used as _________________________ or /and (in case of goods)

(ii) for manufacturing of ______________________________________ (in case of technology)

b) The item(s) indicated in PART 2 are being processed or incorporated into another product (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;

d) Post shipment verification of the items at end users site shall be allowed if required by the Government of India, as may be applicable;

¹ for definition of software and technology refer to the glossary of SCOMET Appendix-Ill. Also refer to the general technology note and general software note and the general information security note of SCOMET Appendix-III

² For Technology exports, value should be mentioned (if applicable) in Part 2

e) 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/policy;

f) 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);

g) It is also certified 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.

PART 4: SPECIFIC DETAILS OF AUTHORIZED SIGNATORY (mandatory):

a. Name (in capital letters only): ______________________________

b. Designation: ____________________________

c. Complete office address (with room No. area, city, district, state, country) : ___________

d. Pin/Zip/Postal Code : _______________________

e. Telephone number (with ISD code): _________________________ or

f. Mobile No. : ___________________ Alternate mobile number (if any): _____________

g. Fax No with ISD Code. : __________________ (if any)

h. Primary Email: _______________________________ Alternate email: _____________________

Specific details of alternate contact person authorized for the purpose (optional):

Same as (a) to (h) above

Signature (authorised signatory): ________________________________________

Official seal / stamp:

Date of issue:

Validity date (specify the period, if any):

PART 5 - CERTIFICATION ON BEHALF OF THE RECEPIENT STATE IF NOT PARTY TO CWC³ [To be filled by the concerned Government Department / authorised agency of state (country)]

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 of issue ______________________________________________

(signature of official government representative)

Name (in capital letters only): ___________________________________________ Designation ________________________

Government Department/Ministry stamp

Name of Organization & Contact details (Tele / Fax No (with ISD code) and Email : _______________________________

³ For list of states (countries) not party to the Chemical Weapons Convention(CWC), please refer to OPCW website (presently Egypt, North Korea (DPRK), and South Sudan have not signed to CWC. Israel has signed but not ratified to the convention)
 

Note : [Please read carefully]

1. Stock and Sale is not permitted for SCOMET Category 0, Category 3A4001, Category 6 and transfer of technology in any category

2. Please indicate full details of end use under declaration in Part 3(a)

3. Strike out, if any entry is not applicable

4. Any additional sheet must be on the letterhead of the company and signed by the same person who signs this form

5. Other than Stock and Sale purposes, EUC proforma Appendix 2S(i) or Appendix 25(ii), as applicable, will apply

PART 1: DETAILS OF THE ENTITIES

(a) Name of Exporter in India :

(b) Name of Stockist entity:

(c) Address of the Stockist entity :

(d) Details of relationship between exporter and stockist :

(e) Specific Location where the items will be held in stock/assembled [if different from (c)]*

(f) List of countries to which goods are to be transferred on receipt of orders:

*Remarks: The goods will be stocked at the premises of the Stockist and shall not be re-transferred / sold without the consent of the Government of India, unless specifically exempted in the export authorization /policy.

PART 2: ITEMS
 

PART 3: DECLARATION

a) The item(s) indicated in PART 2 will be used as capital equipment/ component / raw material / others¹ ____________________ (select one) for use as (indicate full details of end use): ________________________

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.

c) Post shipment verification of the items at end users site shall be allowed if required by the Government of India, as may be applicable.

¹ Please indicate the use

d) The stockist 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 the stockiest entity) or outside it unless specifically exempted in the export authorization/policy.

e) I/We further certify that the goods are intended for stock to be held against future orders and that the consent of the Government of India will be obtained for any transfer to end- users in the countries mentioned in Part 1(f) above unless specifically exempted in the export authorization/policy. We undertake that we shall follow the conditions laid down in the export authorization granted to entity at 1(a) above by the Government of India.

f) 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.

g) 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.

PART 4: SPECIFIC DETAILS OF AUTHORIZED SIGNATORY (mandatory):

a. Name (in capital letters only): ________________________________________

b. Designation: ____________________________

c. Complete office address (with room No. area, city, district, state, country) : ________________

d. Pin/Zip/Postal Code : _______________________

e. Telephone number (with ISD code): __________________ or

f. Mobile No. : __________________________________ Alternate mobile number (if any): _________________________

g. Fax No with ISD Code. : _____________________ (if any)

h. Primary Email: ________________________ Alternate email: _____________________________

Specific details of alternate contact person authorized for the purpose (optional):

Same as (a) to (h) above

Signature (authorised signatory): ___________________________________________

Official seal / stamp of the entity:

Date of issue:

Validity date (specify the period, if any):

(Above EUC proforme, namely, Appendix 2S(i), 2S(ii) and 2S(iii) are substituted vide PUBLIC NOTICE NO. 04/2019, DT. 12/04/2019)

--------------------------------------------------------------------------------

[OLD- APPENDIX- 2 S (i)

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)
 

(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 product2 (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.
 

[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 ]
 

PART 1: PARTIES CONCERNED

(a) Name of Exporte ____________________________________________________
(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
 

(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 certif y 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.
 

PART4 - CERTIFICATION ON BEHALF OF THE RECEPIENT STATE

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.
 

[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

(Above Revised formats for End use cum End User Certificate have been prescribed vide PUBLIC NOTICE NO.04/2017, DT. 24/04/2017)

PART 1: PARTIES CONCERNED

(a) Name of Exporter in India __________________________________________________________________________________

(b) Name of Stockist entity____________________________________________________________________________________

(c) Address of the Stockist entity________________________________________________________________________________

(d) Details of relationship between exporter and stockist______________________________________________________________

(e) Specific Location where the items will be held in stock/assembled (if different from ( c ) ) ___________________________________
_________________________________________________________________________________________________________

(f) Exhaustive list of countries to which goods are to be transferred on receipt of orders: _______________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________

PART 2: ITEMS (goods, software, technology)
 

(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 (select one) 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, is may be applicable.

c) The stockist shall not himself, or though 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 the stockiest entity) ___________________________________________ or outside it.

d) We further certify that the goods are intended for stock to be held against further orders and that the consent of the Government of India will be obtained for any transfer to end-users in the countries mentioned in Part 1 (f) above, We undertake that we shall follow the conditions laid down in the export authorization granted to entity at 1(a) above by the Government of India.

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, unclear 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.
 

[To be submitted on the letterhead of the stockist entity. Any additional sheets must be signed by the same person who signs this form.]]

( Above Appendix- 2S (iii), the format for the End use cum End User Certificate (EUC) in case of export of SCOMET items for stock and sale purpose has been vide PUBLIC NOTICE NO.07/2017, DT. 17/05/2017 )