Reportddddd
Reportddddd
END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF SCOEMT CATEGORY 1 ITEMS
(For SCOMET Category 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 authorized signatory]
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-10J(i)and for Stock & Sale
proformaAppendix 10J(iii)will apply
__ _ __ _ __ _ __ _ _ _ _ __ _ _ __ _ _ ___
*Remarks: The items will be installed at the premises of the end-user or will be used only by the end-user.
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 PARAGUAY__ _
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, asmay
be applicable;
6 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
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)
PARAGUAY 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 andbelief
and that I/we do not know of any additional facts that are inconsistent with this certificate.
Specific details of alternate contact person authorized for the purpose (optional):
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:
Signature:
(Signature of authorized signatory)
PART 5: CERTIFICATION ON BEHALF OF THE RECEPIENT STATE IF NOT PARTY TO CWC3 [To be filled by the
concerned Government Department / authorized agency of state (country)] [NOT APPLICABLE]
As an authorized 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 purpose 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.
Name of Organization & Contact details (Tele / Fax No (with ISD code) and email :
3 For lit 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)
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