APPENDIX- 2 S (iv)

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) Intermediary Name (if any)________________________________________________________________________________

c) Intermediary Address (if any) _____________________________________________________________________________

d) Name of End User ______________________________________________________________________________________

e) End-User’s Address ______________________________________________________________________________________

f) Zip code ______________________ Tele No.__________________________ Email__________________________ Fax __________________________

g) Specific Location where the items will be used (if different from (e)) __________________________________________________________________

h) Nature of usual business of the End-User (e.g. manufacturer or research) _______________________________________________________________

i) Business relationship with the applicant exporter (foreign subsidiary company or foreign parent company / another subsidiary of foreign parent company ________________________________________________

j) How long has your business relationship with the applicant exporter existed? ________________________________________________ 

PART 2: ITEMS (goods, software, technology)

(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 in to another product (as detailed in 3a above), for sale to ultimate end users located in__________________________

c) Purpose of import by End User (R&D/testing/Calibration/ demo/design/encryption/delivery/validation/import after repair/others, etc). __________________________

d) 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.

e) Further re-export /re-transfer of the item including software and technology from the foreign subsidiary company or foreign parent company / another subsidiary of foreign parent company to end users in other countries would be subject to the export control regulations of the country of the foreign subsidiary company or foreign parent company / another subsidiary of foreign parent company.

f) I/we certify that the items including software and technology indicated in part 2 is/are to be 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.

g) I/we certify that I/we will provide DGFT, Government of India with delivery verification certificate upon its request. h) 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. In case the above mentioned item(s) include(s) technology, we certify that it will be treated as strictly confidential.

i) End Use of the items shall not be changed nor the items modified or replicated without the prior consent of the Government of India (This will be optional in case the ownership/patent of the items is with the foreign parent company).

j) I/we shall not myself/our self, 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.

k) 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.

l) 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.

m) 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 subsidiary company or foreign parent company / another subsidiary of foreign parent company on its letterhead indicating full chain of supply in case 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)