End User Certification for Exported Goods

Online End User Certification (EUC) Form. In accordance with United States export laws, it is the policy of Pine Research Instrumentation to verify the end-use, end-user, and intermediate entities for all exported shipments of our products, related technology, and software. We require obtaining a completed End-User/End-User Certificate (EUC) and store the certificate on file, which is necessary to release an exported order for shipment. Contact Pine Research Instrumentation if you have any questions about completing this form. Exported orders will not be processed or shipped until we have received this completed form.

Section I. Please review the text in the following section. (REQUIRED)

As dictated by United States export control law, this End Use Certificate certifies the following regarding the good being imported or exported:

Will not be imported, re-exported or transferred to be used in the design, development, production, stockpiling, or use of chemical or biological weapons and their precursors.
Will not be imported, re-exported or transferred to be used in the design, development, production, stockpiling, or use of missiles, rocket systems or unmanned air vehicles of any range or payload. “Rocket systems” include, but are not limited to, ballistic missile systems, space launch vehicles, and sounding rockets. “Unmanned air vehicles” include, but are not limited to, cruise missile systems, target drones and reconnaissance drones.
Product and/or replicas (“replicas” refers to items produced abroad on physical examination of the item originally exported, matching it in all critical design and performance parameters) thereof will not be used (either directly or indirectly) in sensitive nuclear end-uses, as follows:
1. Nuclear explosive activities: Nuclear explosive activities, including research on or development, design, manufacture, construction, testing or maintenance of any nuclear explosive device, or components or subsystems of such a device.
2. Unsafeguarded nuclear activities: Activities including research on or development, design, manufacture construction, operation, or maintenance of any nuclear reactor, critical facility, facility for the fabrication of nuclear fuel, facility for the conversion of nuclear material from one chemical form to another, or separate storage installation, where there is no obligation to accept International Atomic Energy Agency (IAEA) safeguards at the relevant facility or installation when it contains any source or special fissionable material (regardless of whether or not it contains such material at the time of export), or where any such obligation is not met.
3. Safeguarded and unsafeguarded nuclear activities: Safeguarded and unsafeguarded nuclear fuel cycle activities, including research on or development, design, manufacture, construction, operation or maintenance of any of the following facilities, or components for such facilities for the:
  1. Facilities for the chemical processing of irradiated special nuclear or source material;
  2. Facilities for the production of heavy water;
  3. Facilities for the separation of isotopes of source and special nuclear material; or
  4. Facilities for the fabrication of nuclear reactor fuel containing plutonium.
The goods will not be imported, re-exported or transferred to be used in the design, development, production, construction, support, or maintenance of a maritime nuclear propulsion project; including any machinery, devices, components or equipment specifically developed or designed for use in such plants or facilities.
Will not be imported, re-exported or transferred to be used in crime control and detection commodities and end-uses.
Will not be imported, re-exported or transferred to destinations embargoed by the U.S. government (unless deminimus provisions apply).
Will not be imported, re-exported or transferred to entities listed on U.S. government denial lists: U.S. Department of Commerce Denied Persons List, Treasury Department Specially Designated Nationals and Blocked Persons Lists, State Department Debarment List, and State Department Parties of Proliferation Concern.
Will not be imported, re-exported or transfered for use by the end-users listed on the Entity List, Supplement No. 4, Part 744 of the EAR without approval from the U.S. Department of Commerce or the Pine Instrument Company International Dept.
Will not be imported, re-exported or transferred to be used by persons on the Unverified List as published by the U.S. Department of Commerce Bureau of Industry and Security.
Written Authorization will be obtained from the Bureau of Industry and Security prior to re-exporting the items or technology, unless they would be eligible for export from the United States to the new country of destination under U.S. export law.
Will not be used, sold, resold, delivered or transferred, directly or indirectly, contrary to U.S. export regulations.
Will not be imported or re-exported for use by or for by persons who commit, threaten to commit or support terrorism. The term terrorism means an activity that:
1. Involves a violent act or an act dangerous to human life, property, or infrastructure; and
2. Appears to be intended:
  1. to intimidate or coerce a civilian population;
  2. to influence the policy of a government by intimidation or coercion; or
  3. to affect the conduct of a government by mass destruction, assassination, kidnapping or hostage taking.

End User Certification of Exported Goods

All orders from Pine Research Instrumentation that are destined to be exported for use outside of the United States requires that the parties involved (end-user, intermediate consignee, and ultimate consignee) disclose the parties involved in the transaction. By signing this form, parties acknowledge having read and understood export restrictions and requirements.

Section II. Order Number and End-Use Delcaration (REQUIRED)
This is to certify that the good(s) imported or exported from Pine Research Instrumentation, Inc. under purchase order number:*

purchase order or order reference number
will be destined for the following use/application.*
NOTE: please be fairly specific. A statement such as "for use in a laboratory" or "for R&D purposes" are not sufficiently specific.
Further, the good(s) will not be destined for end uses listed as described previously, as dictated by United States export control law.
Section III. Ultimate Consignee (End-User) (REQUIRED)
The person who will actually be using the products must identify themselves in this section. Purchasers (including purchasing agents and/or administrative staff, whether 2nd or 3rd party to the end-user) must obtain these details from their end-user.
Name*
First Last
Organization Name*

with what company or academic institution are you affiliated?
Ultimate Consignee (End-User) Complete Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This should be the address of where the end-user shall use the imported good(s).
Is the Ultimate Consignee (End-User) also the same person as the Intermediate Consignee (Purchaser/Receiver)?*
An Intermediate Consignee (Buyer/Receiver) may or may not be the same person as the Ultimate Consignee (End-User). When they are different people (for example, a University purchasing officer places an order on behalf of a student in a laboratory in their department), select "No" and complete the unique fields for the Intermediate Consginee (Buyer/Receiver) below. If the end user is also the purchasing contact, select "Yes" to skip this section.
Skipping Section IV. Intermediate Consignee (Purchaser/Receiver)
Section IV. Intermediate Consignee (Purchaser/Receiver)
If an intermediate entity (Primary Purchaser) orders product(s) from Pine Research Instrumentation on behalf of their customer (End-User), the Primary Purchaser must complete this section.
Name*
First Last
Organization Name*

with what company or academic institution are you affiliated?
Intermediate Consignee (Buyer/Receiver) Complete Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Complete this section for an Intermediate Consignee (Purchaser/Receiver) who is a different person than the Ultimate Consignee (End-User).
Will an Additional Consignee (Third-Party Agent) be involved in this purchase?*
An Additional Consignee (Third-Party Agent) is neither the End-User nor the Intermediate Consignee (Buyer/Receiver). Select "Yes" if, for example, the purchaser of the goods plans to resell them to another entity, who is not the end user. Otherwise, select "No" to skip this section.
Skipping Section V. Additional Consignee (Third-Party Agent)
Section V. Additional Consignee (Third-Party Agent)
In some cases, an Additional Consignee (Third-Party Agent) may initiate a purchase with Pine Research. The goods are shipped to the Intermediate Consignee (Buyer/Receiver), who may or may not be the End User. In this circumstance, the Additional Consignee (Third-Party Agent) must complete the unique address fields below.
Name*
First Last
Organization Name*

with what company or academic institution are you affiliated?
Additional Consignee (Third-Party Agent) Complete Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Complete this section for an Intermediate Consignee (Purchaser/Receiver) who is a different person than the Ultimate Consignee (End-User).
Section VI. Signature Verification (REQUIRED)
Name*
First Last
Email Address*
Enter Email Confirm Email

In case we have questions about this form or need clarification, we will contact the person who has submitted the electronic EUC.
Title or Role*
By clicking "Yes, I understand" box below, I hereby certify that I have read and understand the Export Compliance Statement provided at the beginning of this form. I am a responsible principal of my organization, authorized to legally obligate my organization and that I am authorized to sign this End-Use/End-User Certification for U.S. Export Compliance.*
- Yes, I understand
Signature*
Date*
MM slash DD slash YYYY

End User Certification for Exported Goods

Section I. Please review the text in the following section. (REQUIRED)

As dictated by United States export control law, this End Use Certificate certifies the following regarding the good being imported or exported:

End User Certification of Exported Goods

Section II. Order Number and End-Use Delcaration (REQUIRED)

Section III. Ultimate Consignee (End-User) (REQUIRED)

Skipping Section IV. Intermediate Consignee (Purchaser/Receiver)

Section IV. Intermediate Consignee (Purchaser/Receiver)

Skipping Section V. Additional Consignee (Third-Party Agent)

Section V. Additional Consignee (Third-Party Agent)

Section VI. Signature Verification (REQUIRED)