Council Regulation (EU) No 267/2012 of 23 March 2012 concerning restrictive measures against Iran and repealing Regulation (EU) No 961/2010

Annex IIA - End-use statement referred to in Articles 3a(6) and 3c(2) and point (b) of Article 3d(2)

(Letterhead of the end-user/consignee in the country of final destination)

END-USE STATEMENT

(if issued by the governmental authority, please insert a unique identifying number ‘No…’)

A.   Parties

1. Exporter (name, address and contact details)

2. Consignee (name, address and contact details)

3. End-user (if different from consignee)

4. Country of final destination

B.   Items

1. Items (detailed description of items)

2. Quantity (units) / weight

3. End-use (specific purpose for which the items will be used. If the items are to be incorporated into or used for the development, production, use or repair of another item, please describe that item, its purpose and its end-user)

4. Specification of the end-use location of the items (unless the consignee acts as trader, wholeseller or reseller and is not aware of the end-use location of the items)

C.   Statement of foreign consignee

C.1   Consignee acts as end-user

Articles 3a(6) and 3c(2) and point (b) of Article 3d(2) of Council Regulation (EU) No 267/2012 require the applicant for an authorisation to submit this end-use statement or an equivalent document containing information on the end-use and end-use location of any supplied item.

We (I) state that the items described in Section B supplied by the exporter named in Section A 1:

1. will only be used for the purposes described in Section B 3 and that the items or any replica thereof, if applicable, are intended for final use in the country named in Section A 4, in the location specified in Section B 4;

2. that the items or any replica thereof, if applicable:

— will not be used in any nuclear explosive activity or unsafeguarded nuclear fuel-cycle activity;

— will not be used for any purpose connected with chemical or biological or nuclear weapons, or missiles capable of delivering such weapons;

— will only be used for civil end-uses;

— will not be retransferred within Iran without prior information to the exporting State.

C.2   Consignee acts as trader, wholeseller or reseller (only to be completed if Section C.1 is not applicable)

Articles 3a(6) and 3c(2) and point (b) of Article 3d(2) of Council Regulation (EU) No 267/2012 require the applicant for an authorisation to submit this end-use statement or an equivalent document containing information on the end-use and end-use location of any supplied item.

We (I) state that the items described in Section B supplied by the exporter named in Section A 1:

1. will only be used for the purposes described in Section B 3 and that the items or any replica thereof, if applicable, are intended for final use in the country named in Section A 4

2. that the items or any replica thereof, if applicable:

— will not be used in any nuclear explosive activity or unsafeguarded nuclear fuel-cycle activity;

— will not be used for any purpose connected with chemical or biological or nuclear weapons, or missiles capable of delivering such weapons;

— will only be used for civil end-uses;

— will only be delivered to a third person/company on condition that that third person/company accepts the commitments of the above declaration as binding for itself and on condition that that third person/company is known to be trustworthy and reliable in the observance of such commitments.

If applicable:

Stamp of chamber of commerce

(or other legalising authority)