49 Rider Avenue, Patchogue, NY 11772

L-3 Narda-ATM

Tel: 631 289-0363 ● Fax: 631 289-0358

Web:

STATEMENT OF ULTIMATE CONSIGNEE AND PURCHASER: We certify that all of the facts contained in this statement are true and correct to the best of our knowledge and we do not know of any additionalfacts which are inconsistent with the above statement. We shall promptly send a supplemental statement to the U.S. Exporter, disclosing any change of facts or intentions set forth in this statement which occurs after the statement has been prepared and forwarded, except as specifically authorized by the U.S. Export Administration Regulations (15 CFR parts 730-774), or by prior written approval of the Bureau of Industry and Security, we will not re-export, resell, or otherwise dispose of any items approved on a license supported by this statement (1) to any country not approved for export as brought to our attention by means of a bill of lading, commercial invoice, or any other means, or(2) to any person if we know that it will result directly or indirectly, in disposition of the items contrary to the representations made in this statement or contrary to Export Administration Regulations.

END-USER CERTIFICATE

Dear Valued Customer,

Export of Narda-ATM products may be subject to either the United States Government’s Export Administration Regulations (“EAR”) or International Traffic in Arms Regulations (“ITAR”). Please complete and return this certificate so we may process your purchase order [PO] or request for quotation [RFQ].

RFQ or PO No.: / RFQ or PO Date:
Qty / Model number(s) / Description (attach additional sheet, if necessary):

Purchaser Information: End User Information:

Company: / Company:
Address: / Address:
City/Province: / City/Province:
Country/Postal: / Country/Postal:
Telephone: / E-Mail: / Additional Information:
Contact Name:

*The specific end use box below and the Military or Civil end use check must be completed or form will be deemed incomplete which may affect your order from being processed.

*SELECT ONE: □Military End Use□ Civil End Use

*Specific End-Useapplication(attach additional sheet, if necessary): IE: (Radar, Satcom, cellular)

By signing below, ______(Your Company Name) certifies that the items herewith 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. The items will not be re-exported as such without the prior written consent of the US Government.

Signature of Authorized CompanyOfficer______

Name (Printed): ______

Title: ______Date(mm/dd/yyyy):______

PLEASE TYPE or PRINT CLEARLY. RETURN BY Email: [