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Kevin Justine, an employee of Technical Sales, certified in a statement of end use that goods/services will be used by an oil and gas company in Malaysia. He acknowledged the goods will not be used for weapons, unsafeguarded nuclear activities, or Russian energy projects. Kevin certified he is authorized to sign, the information is correct, and the company will comply with export control laws and not sell to embargoed entities.

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Dgc Labuan
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42 views1 page

1

Kevin Justine, an employee of Technical Sales, certified in a statement of end use that goods/services will be used by an oil and gas company in Malaysia. He acknowledged the goods will not be used for weapons, unsafeguarded nuclear activities, or Russian energy projects. Kevin certified he is authorized to sign, the information is correct, and the company will comply with export control laws and not sell to embargoed entities.

Uploaded by

Dgc Labuan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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(Printed on end user letterhead)

STATEMENT OF END USE

END USER COMMITMENT:


I, the undersigned, (name & surname) Kevin Justine ( Kevin)
..................................................................................................................
As an Employee of the company (name) Technical Sales
...............................................................................................................
(Company address) DG CONTRACTOR Lot 51, 1st Floor, Block E, O&G Sec Lazenda Warehouse,
..............................................................................................................................................
Jalan Rancha-Rancha, 87007 Labuan F.T Malaysia.
with authorization powers,
do hereby acknowledge that the goods/services described below (description of goods/services)
..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
will be used in (address & country of destination) ..................................................................................................
……………………………………………………………………………………………………………………………………
on the project / implant of (name of project/implant) ..............................................................................................
for the sole purpose of (End user industry type) (please tick the right answers):

/
☐ Oil and gas ☐ Chemical ☐ Nuclear, radioactive
☐ Power ☐ Water / wastewater ☐ Chemical or biological weapon
☐ Fertilizers ☐ Biotechnology ☐ Military
☐ Food / Beverage ☐ Pharmaceutical ☐ Other (please, precise)
....................................................
I certify that the items or goods described above:
1. will only be used for the purposes described above,
2. are intended for final use by the end-user in the country described above,
3. are not be used as war equipment, such as defined by regulations of France, European Union and United States
(ITAR),
4. will not be used in any nuclear explosive activity or unsafeguarded nuclear fuel cycle,
5. will not be used for any purpose connected with any chemical or biological or nuclear weapons, or missiles capable
of delivering such weapons,
6. will not be used directly or indirectly for exploration or production in Russia's energy sector from deep water, Arctic
offshore, or shale projects in Russia that have the potential to produce oil or gas.

Export Control:
Our company assumes full liability for our actions for licensing related to these goods/services for subsequent exports
or re-exports, if legally required.
I recognize that the Goods/services will not be knowingly sold to any country, company or individual listed on the
European Community, France or U.S. Governments Embargoed Country List, EU, France or US Denied Person Lists,
Entity List and Supplements or any other applicable export control law or regulation. I recognize that Vendor may
terminate sales agreement if Customer provides unreliable information to Vendor, knowingly or unknowingly.
I acknowledge that failure to follow EU regulations EU 2021/821, EU 833/2014, French and U.S. Department of
Commerce regulation, or any other applicable law guidelines, may result in fines, denial of export licenses privileges,
and/or criminal prosecution.

I certify that (1) I am authorized to sign on behalf of the Company, (2) the information provided above is
correct and sincere.
Signature
..............................................................................................................................................................................
NAME in CAPITAL letters (typed or handwritten)
..............................................................................................................................................................................
Professional Title ..................................................................................................................................................
Date signed ..........................................................................................................................................................
Company Seal

MRE AQFORMJU007 – REV.06 – 092021

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