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End Use-End User Certificate Blank

This document is an end user/end use certificate to be filled out and signed by a business partner. It certifies that any products received will not be resold, exported, or used in violation of export regulations. It also confirms the business partner will not provide products to sanctioned individuals, entities, or countries. The certificate requires information on the end user such as name, address, and intended use of the products. Both the business partner and end user must sign and stamp the certificate.

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delson
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832 views2 pages

End Use-End User Certificate Blank

This document is an end user/end use certificate to be filled out and signed by a business partner. It certifies that any products received will not be resold, exported, or used in violation of export regulations. It also confirms the business partner will not provide products to sanctioned individuals, entities, or countries. The certificate requires information on the end user such as name, address, and intended use of the products. Both the business partner and end user must sign and stamp the certificate.

Uploaded by

delson
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Please return this document filled-in, duly signed and stamped to GenMar LATAM

Email to: soporte@genmar-latam.com

End Use/End User Certificate

The Business Partner hereby acknowledges that furnished products might be subject to various Export
Regulations (e.g. stipulated by the United Nations (UN), the European Union (EU), the United States of
America (US) and other potentially applicable export control laws referred to therein, including without
limitation Embargo and Sanctions Regulations, e.g. issued by UN, EU, US, etc.

The Business Partner agrees and expressly certifies that neither itself nor its agents, representatives or
employees, will cause or facilitate the resale, export, re-export or servicing of supplied
goods/technology/software, directly or indirectly through a third- party contrary to applicable Export
Regulations. It will fully comply with the applicable regulations and obtain all authorizations in writing from
the respective authorities in charge.

Especially, the Business Partner confirms that it will not perform any of the above actions to individuals or
entities or countries for which an embargo is applicable to the specific transaction, e.g. maintained by the
UN, EU, US, etc. OR which are listed on applicable Denied Person’s Lists issued by the UN, EU, US, etc.

The Business Partner hereby certifies that the final destination and end-use of the product is:

1. Name of End User (official company name, no abbreviations):

2. Address/ Location where the products will be installed:


a. ☐ Plant name, complete address, and country:

b. ☐ Offshore Platform (name, field name, exact location, and country):

________________________________________________________________________________

c. ☐ Vessel name: (Including ship owner and country of registration):

3. End Use of Products (please check selection):


a. ☐ Civilian industrial application only
b. ☐ Civilian nuclear application/facility
c. ☐ military application

4. Nature of End User’s industry (please check selection):

☐ Oil ☐ Gas ☐ LNG ☐ Food/Beverage ☐ Safety ☐ Mining

☐ Steel ☐ Power ☐ CNG ☐ Petrochemical ☐ Cement ☐ PET

☐ Others:
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5. Reference (Project PO):

End_User_Certificate/2021-8
CERTIFICATE ENDORSMENT

Business Partner End User

Company Name: _________________________ Company Name: _________________________

Complete Address: Complete Address:


_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________

State/Province: __________________________ State/Province __________________________

Country: ________________________________ Country: _______________________________

Phone number: __________________________ Phone number: __________________________

Email: __________________________________ Email: __________________________________

Print Name: _____________________________ Print Name: _____________________________

Title / Function: _________________________ Title / Function: _________________________

Place / Date: ____________________________ Place / Date: ____________________________

Signature: _______________________________ Signature: _______________________________

Stamp: Stamp:

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Page

End_User_Certificate/2021-8

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