APPENDIX-2 S(ii)
END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF SCOEMT CATEGORY 1 ITEMS
(For SCOMETXategory 1 (chemicals) only and re-export from Stockist to ultimate end user under Stock & Sale for Category 1)
[To be filled by all entities in the chain of supply e.g. foreign buyer / consignee / end user / intermediary(ies), if any on the letterhead of the respective entity, duly signed in ink by authorised signatory]

                                                                                                                                                                                                    

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 2S(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)¹ 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) l/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-Ill
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 l/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:                     

                                                
³For 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)