Appendix 10J (i)

END USE CUM END USER CERTIFICATE FOR EXPORT OF SCOMET ITEMS
(For SCOMET Categories 2,3,4,5 & 8 and re-export from Stockist to ultimate end user under Stock & Sale for all eligible categories other than Category 1 – chemicals)

[To be filled by all the entities involved in supply chain 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 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 -10J(ii)and for Stock & Sale proforma Appendix 10J(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)3will 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 / other⁵      __________(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);
        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;

_________________________
³ 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 4 For Technology exports, value should be mentioned (if applicable) in Part 2 5 Please indicate the use

      f)  The end-user shall not himself, or through another, cause the items, or replicas, or derivatives thereof to be reexported / 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):