End-User Certification – Seal Dynamics

End-User Certification Form

Please complete all four sections, sign, and submit. A PDF copy is emailed on submission.

Export of these commodities is subject to the U.S. Government's Export Administration Regulations ("EAR") or International Traffic in Arms Regulations ("ITAR"), and to regulations enforced by the U.S. Treasury Department's Office of Foreign Assets Control ("OFAC"). Please complete and return this certification so we may complete the review of your purchase order or request for quotation.

All four sections must be completed.

Section 1

P.O. No. * P.O. Date *

Product Information *

At least one product line is required (Quantity, Part or Model number, and Description).

Quantity	Part or Model number	Description

Section 2

Purchaser Information

Company * Website

Street Address *

City * State Zip/Postal Code

Country *

Contact Name Tele# E-mail

Intermediate Party(ies) Information (if none, enter "None")

Company * Website

Street Address

City State Zip/Postal Code

Country

Enter “None” as the Company if there is no intermediate party. If you name an intermediate party, complete its full address.

End-User Information

Company * Website

Street Address *

City * State Zip/Postal Code

Country *

Section 3 Specific End-Use * — provide a complete, detailed statement of the end-use application of the product(s) above.

Aircraft (if applicable) Tail No. (if applicable)

A) Select one or more end-use: * Military End-Use Civil End-Use

B) Select one or more end-user: * Military End-User Civil End-User

Section 4 — Declaration

By signing below, your company declares that:

The company will act in full compliance with the laws and regulations of the U.S. Department of State, Department of Commerce and Department of the Treasury, including but not limited to the Arms Export Control Act, Export Administration Act, Foreign Corrupt Practices Act, Anti-Boycott Law, and their implementing regulations, including regulations enforced by OFAC.
The item(s) will not be used for any purpose connected with chemical, biological, or nuclear weapons, or missiles capable of delivering such weapons, nor will they be resold if we know or suspect that they are intended or likely to be used for such purpose.
In addition to the license requirements for items specified on the Commerce Control List (CCL) (Supplement No. 1 to part 774), you may not export, reexport, or transfer (in-country) as outlined/defined within 15 CFR 744.21, including supplements, regarding restrictions on certain 'military end uses' or 'military end users' general prohibitions pertaining to Belarus, Burma, Cambodia, the People's Republic of China (China), Nicaragua, Russia or Venezuela.
I am authorized to submit this certification on behalf of the purchaser identified in Section 2.

I verify that all information contained in this document is true and accurate to the best of my knowledge.

Authorized Title * Date *

Name (printed) *

Signature *

Verify your email *

Enter your email, request a code, and enter the 6-digit code we email you to confirm your identity.

Your email address Verification code

By submitting this form you consent to Seal Dynamics processing the information you provide — including your IP address, browser, and the date and time — to review, complete, and keep a record of this export certification. See our privacy policy. Seal Dynamics will keep a record of this completed certification for a period of at least 10 years and a copy of your submission can be obtained by submitting a request to sdcustomerservice@sealdynamics.com.

Your email address *

A copy of the completed certification will be emailed to this address.

Please forward the copy you receive to your Seal Dynamics Customer Service Representative for confirmation.

You can send us an email and we'll get back to you asap.

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