(Print on Company Letterhead)
Sales Order No.: Sales Order No.Distributor Agmt. No: Distributor Agmt. No.
CERTIFICATION for 9Hz THERMAL IMAGING PRODUCTS
We, Full Legal Name of Company, located atCompany Address,hereby acknowledge that the Products set forth on the attached Exhibit A (the “Products”) are classified under Export Control Classification Number (“ECCN”) 6A993.a for U.S. export control purposes and may not be exported, re-exported, or transferred to a “Military End-User” in any country except the U.S. or Canada, except as approved under a U.S. export or re-export license. “Military End-User” means national armed services (army, navy, marine, air force, coast guard), national guard, national police, government intelligence or reconnaissance organizations. Military End-User also means any person or entity whose actions or functions are intended to support Military End-Uses, which meansincorporation into a military item described on the U.S. Munitions List or the Wassenaar Munitions List, or to commodities classified under any U.S. Commerce Control List “600” series ECCN, ECCN ending in “A018,” or ECCN “0A919,” or any commodity that is designed for the development, production, use or deployment of military commodities (regardless of country of origin) that are described on the U.S. Munitions List or the Wassenaar Munitions List, or classified under any U.S. Commerce Control List “600” series ECCN, or ECCN ending in “A018,” or ECCN “0A919.”
Accordingly, we:
- Will not export, re-export, sell or otherwise transferany of the Products to a Military End-User outside the United States or Canada. This includes selling or transferring the product to anyone with knowledge that the Product will be exported or transferred to Military End-User or Military End-Use, as defined above. Should we determine at any point that the Product will be sold, directly or indirectly, to a Military End-User or for a Military End-Use, we will obtain the required U.S. export/re-export license, or contact ( for licensing assistance).
- Will not incorporate the FLIR product into a military commodity, unless authorized under a U.S. export license or other approval.
- Will not directly or indirectly export, re-export, sell or otherwise transfer or dispose ofthe Products to any U.S.-sanctioned or embargoed country or territory, including Crimea, Cuba, Iran, North Korea, Republic of Sudan, or Syria, unless authorized by the U.S. Government.
- Will not directly or indirectly export, re-export, sell or otherwise transfer or dispose ofthe Products to any U.S.-sanctioned person, company, entity or other party, including parties listed on the Specially Designated Nationals and Blocked Persons List (“SDN List”) maintained by the U.S. Office of Foreign Assets Control; and the Entity List, Unverified List and Denied Persons List maintained by the U.S. Department of Commerce, Bureau of Industry & Security.
- Will not directly or indirectly, export, re-export, sell or otherwise transfer or dispose of the Products to any person, company, entity or other party, for use in design, development, production or use of nuclear, chemical or biological weapons, or missiles, or to any entity that engages in such activity, unless authorized by the U.S. Government.
The undersigned is authorized to make these representations and certifications on behalf of the company named above.
Signature: ______Date: Insert date
Print Name: Insert NameTitle: Insert Title
4209892 Rev. A 01/19/2017