End-Use Certificate for Dual-Use Items (EU Reg. 428/2009) (if issued by the government authority, a unique identifying Certificate number N° ...) A. Parties 1. Exporter 5. Please describe the route the items will take: Name: Company Registration Number: Website: Registered Address: Contact Person + Tel. + E-mail: 6. Country of Final End Use: 2. Consignee Name: Company Registration Number: Website: Registered Address (no PO Box): If different; shipping address: Contact Person + Tel. + E-mail: 3. End-User (if different from Consignee) Name: Company Registration Number: Website: Registered Address (no PO Box): If different; shipping address: Contact Person + Tel. + E-mail: 4. Other involved entities (agent, broker, transporter, reseller, etc…) (please indicate name, full address, and contact details) B. Items 1. Items
End-Use Certificate for Dual-Use Items (EU Reg. 428/2009) (if issued by the government authority, a unique identifying Certificate number N° ...) A. Parties 1. Exporter Name: Company Registration Number: Website: Registered Address: Contact Person + Tel. + E-mail: 5. Please describe the route the items will take: 6. Country of Final End Use: 2. Consignee Name: Company Registration Number: Website: Registered Address (no PO Box): If different; shipping address: Contact Person + Tel. + E-mail: 3. End-User (if different from Consignee) Name: Company Registration Number: Website: Registered Address (no PO Box): If different; shipping address: Contact Person + Tel. + E-mail: 4. Other involved entities (agent, broker, transporter, reseller, etc…) (please indicate name, full address, and contact details) B. Items 1. Items
Eindgebruikercertificaat_Word-versie_EN.docx