END-USER STATEMENT - CISTEC

1 SC004 Director-General of Trade and IndustryStrategic Trade Controls BranchTrade and Industry DepartmentTrade and Industry Department Tower700 Nathan RoadKowloonHong KongEND-USER STATEMENT (in support of strategic commodities export licence application)We (name, address, tel and fax nos. of END-USER ) have requested (name and address of HK exporter) to export (description of goods.)

2 Brand, model, type, quantity, value) which we intend to use for (specific detailed end-use of the goods identifying the specific operations to be performed bythe goods in support of the END-USER s business activities)in (country/ place of ultimate destination)We confirm that the goods will be used solely by civil endusers for civil enduse and will not beused in relation to nuclear, biological or chemical weapons or missiles capable of deliveringthese weapons.

3 We also confirm that the goods will not be re-exported or sold to a third of Signatory (in block letters)_____Date of SignaturePosition of SignatoryCompany Chopin the Company- 2 -SC004 Notes(1)End UserFor electronic component assemblies such as integrated circuits, give the name,address, telephone no and fax no of the factory in which the goods are used to repair ormanufacture other computer and other electronic equipment, give the name, address, telephone no andfax no of the factory, company, education/research institute or unit ultimately using intermediate trading or import/export firm is usually not the ultimate user of thegoods.(2)End UseFor electronic component assemblies such as integrated circuits, indicate the endproduct into which the goods are assembled. If the electronic components are to beused to form an integral part of a computer system, completion of the computer andtelecommunications questionnaires is computer and other electronic equipment, explain in detail how the goods will beused.

4 Vague statements such as "for educational purposes", "for accountingapplications" or "for scientific research", etc, are not Note :The data collected in this form will be kept in confidence. They mayhowever be disclosed to other government departments, or to third partiesin Hong Kong or elsewhere, if such disclosure is necessary to facilitateconsideration of the related application, is in the interests of Hong Kong,is authorised or required by the law; or if explicit consent to suchdisclosure is given by the applicant/data other information concerning the handling of personal data by theDepartment, please refer to a relevant Note issued by the Department onthe subject, copy of which is obtainable from the strategic Trade ControlsBranch on 5/F, Trade and Industry Department Tower, 700 Nathan Road,Kowloon, Hong Kong.