Foreign Intermediate Consignee (Purchaser):
Foreign End User:
U.S. Freight Forwarder:
I certify that all the information submitted in accordance with the End-Use Statement is correct and complete. That it is fully and accurately discloses all facts pertinent to this transaction. (s). I further certify that the products purchased will not be used for proliferation of nuclear, missile, chemical or biological warfare. I acknowledge that the making of false statement or concealment if any material fact in connection with this statement may result in imprisonment or fine, or both and denial, in whole or in part, of participation in U.S. exports and re-exports.
The information requested below is required by the United States Export Laws and Regulations, In Lieu of this formal Statement, all of the required information may be included on your Purchase Order.
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