PART A

1 PC07-003 Issue 1 Page 1 of 5 The Secretariat South African Council for Non-proliferation Private Bag X84 PRETORIA, 0001 Tel +27 12 394-3030 Fax +27 12 394-0288 part A Use this form only if you intend exportingcontrolled goods in terms of the Non-Proliferation of Weapons of MassDestruction Act, 1993 (Act 87 of 1993). Interms of the Act all persons involved withcontrolled goods must register with theCouncil. You need to be registered before you canapply for an export permit.

2 Applicationforms are available from the Secretariat. It is essential that you read the separate setof guidance notes before completing thisform. Please answer all questions. The form willbe returned to you if it has not beencompleted in full. Applicants must also note the requirementsof the national conventional arms ControlAct, 2002 (Act 41 of 2002). An exportpermit may also be required in terms of thisAct. To facilitate optical character recognitionthis form must be typed. Only originals ofthis form are to be used.

3 Official use Date received 1 Registered person's name 2 Registration number 3 Address Postal code 4 Consignor's (exporter) name 5 Address Postal Code 6 Nature of consignor's business 7 Consignee's (importer) name 8 Address Country 9 Nature of consignee's business 10 Name of end user 11 Address Country 12 Nature of end user's business EXPORT PERMIT APPLICATION EXPORT PERMIT APPLICATION PC07-003 Issue 1 Page 2 of 5 All previous permits for the same or similargoods to the same destination

4 Must belisted under question 13, including permitsissued under the Armaments Developmentand Production Act, 1968 (Act 57 of 1968). 13 If you have applied before to export the same or similar goods/technology to the same destination state the previous permit number/s. 14 Name of freight forwarder (if applicable) 15 Address Postal code 16 Name of agent through which order came (if applicable) 17 Address Country 18 Date of shipment 19 Carrier 20 Port of export 21 Port of import (also give details of any transit points in between)

5 Yes No Yes No 22 Are the goods intended or likely to be used in the development or production of nuclear, biological or chemical weapons or in systems capable of delivering such weapons? The original signed end-use certificate 23 Do you have any reason to suspect that the goods may be used as described above? EXPORT PERMIT APPLICATION PC07-003 Issue 1 Page 3 of 5 must be submitted with this certificates of the prescribed for-mat are available from the Secretariat.

6 24 What is the intended end use of the goods? Questions 25 to 28 in this section shouldonly be filled in if goods and/or technologiesare temporarily exported for demonstrationor exhibition purposes. Goods must bereturned to the RSA immediately after thedemonstration or exhibition but not laterthan six month's after the date on which thegoods were exported. The Council must be informed in writing when the goods are back in the RSA. Yes No 25 Are the goods/technology intended to be temporarily exported for demonstration or display at an exhibition?

7 26 If yes, what exhibition and where? Yes No 27 Will the goods and/or technology remains under the control of the exporter throughout the period? 28 Proposed date of return If the Secretariat wishes to discuss your application , who may be contacted? 29 Name 30 Street address 31 Telephone (including area code) 32 Fax (including area code) I hereby apply for an export permit in terms of the Non-Proliferation of Weapons of Mass Destruction Act, 1993 (Act 87 of 1993) for the goods listed in part B of this form and declare that all the information furnished is correct.

8 I also certify that the end-user and the end-use as stated are legitimate. Name Signed (authorised signature for the registered person in Question 1) Date EXPORT PERMIT APPLICATION PC07-003 Issue 1 Page 4 of 5 part B SCHEDULE OF GOODS and/or TECHNOLOGIES TO BE EXPORTED Please provide a full description of the controlled goods and/or technologies to be exported, including type, model and serial number where applicable. Full technical specifications of all the controlled goods and detailed descriptions of the controlled technologies must be provided on separate sheets attached to this application.

9 In the case of the re-exporting of imported controlled goods state country of origin where applicable. The Council may under certain circumstances issue open permits for repeated exports of the same goods to the same destination for the same end-use. Additional information is required for an open permit application - please contact the Secretariat. Item Description Country of origin Quantity Serial no The Exporter must adhere to the end-use requirements of the exporting country when imported controlled goods are re-exported as a system or as part of a system.

10 A copy of the end-use certificate must be attached to this application. The Council reserves the right to cancel, amend or suspend a permit that has been issued at any time. The export permit holder indemnifies the Council against any claim for loss or damage which the permit holder or any third party might suffer as a result of the issuing or withdrawal of such permit. An export permit shall not be transferable and the goods listed therein may only be exported by the stated person, firm or company to the country indicated therein.