Instructions For Completion of End-User/End-use Certificate – ITAR

Please fill in every field in red below. Those which are optional, depending on your specifics, are denoted by green type. This page is NOT the EUC form – it is simply the data entry page.

When you fill out this data entry page, Page 2 will be a prepopulated EUC form, printable and ready for signature. Please print, sign and return the EUC Form to Systron Donner.

Letterhead – Please paste a copy of your Company’s Letterhead graphic in the blue box to the right by selecting the blue box and then using either the Insert/Picture or Paste command. If your letterhead graphic does not include address information, please fill them in below.
If you prefer to copy all of the text on page two and paste it onto your corporate letterhead that also meets requirements. /
Your company’s complete address and phone number if not in letterhead graphic / Click here to enter text.
Click here to enter text.
Your company’s website URL / Click here to enter text.
Date - Enter the date of End-User/End-use Certificate. / 7/21/2014
PO # - Enter your purchase order number / Click here to enter text.
SDI Quote # - Enter your SDI Quote # (optional) / Click here to enter text.
Enter your company name / Click here to enter text.
SDI Part Number, Customer Part Number, Part Description and Purchase Quantity –
Enter the complete SDI part number of the commodity you are purchasing, for example: QRS11-00100-100.
Enter your complete part number, if applicable.
Enter the part description, for example: QRS11 Rate Sensor with rate range of ±100°/sec and in the standard performance (-100) configuration.
Enter the total quantity of the purchase, for example: 3. / SDI P/N / Cust.
P/N / Desc. / Qty
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End-User – Enter the complete company name, street, city, state and country of the commodity’s End-User. If your company is the sole user and you will not ship the unit to any other person or company, please enter your company’s full name and address. / Click here to enter text.
End-Use - Check either Civil or Military and enter the program name (if applicable), a description of the system the commodity will be used in and a detailed description of how the commodity will be used in the application. / Choose an item.
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Freight Forwarder – If your shipment is being sent outside the United States and you are using a Freight Forwarder for this transshipment, please list the name, address and phone number in this field. / Click here to enter text.
Consignees – Foreign Consignee1 and Foreign Intermediate Consignee2 (if applicable) must be entered if the commodity will be exported. This requirement applies whether SDI applies for the Export License or the purchaser. For the definitions of the Consignees, see the notes below. If this area does not apply to you (in other words, if the units will not be exported), please enter N/A. / Click here to enter text.
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“Foreign Consignee” is the foreign purchaser who will receive the shipment for storage, modification, or for incorporation into another end-item, and for subsequent forwarding to the foreign end-user. There can be multiple foreign consignees in the transaction.
2 “Foreign Intermediate Consignee” is the person who will receive the goods for onward movement to the foreign purchaser or foreign end-user and/or it is the party involved in the transaction including freight forwarders, custom brokers, agents or representatives, and brokers. There can be multiple foreign intermediate consignees in the transaction.

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Date: July 21, 2014

Attention: Systron Donner Sales Department

2700 Systron Drive

Concord, CA 94518-1399

Subject: END-USER / END-USE Certificate (ITAR)

Reference: Purchase Order Number: Click here to enter text.

SDI Quotation Number: Click here to enter text.

Click here to enter text. acknowledges that the following commodity / commodities, that have been or will be purchased from Systron Donner Inertial (SDI), are controlled by the U.S. Department of State, and are subject to International Traffic in Arms Regulations, 22 CFR Chapter 1, Subchapter M (ITAR) and Significant Military Equipment (SME) Regulations. Click here to enter text. further agrees that export, re-export, resale, transfer, transfer to a foreign national (inside or outside of the United States), or to any party who is listed by the government of the United States as prohibited from receiving the commodity / commodities or from participating in export transactions involving the commodity / commodities without a license issued by the U.S. Department of State, or other restrictions to any destination, end-user, or for any end-use prohibited by the laws of the United States, or any other applicable law where such law does not conflict with the laws of the United States, will not be violated.

SDI Part Number / Customer Part Number (if applicable) / Part Description / Purchase Quantity
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End-User: Click here to enter text.

End-Use: Choose an item.

End-Use Description: Click here to enter text.

Freight Forwarder: Click here to enter text.

Foreign Consignee: Click here to enter text.

Foreign Intermediate Consignee: Click here to enter text.

(signature of authorized representative)

(please print name and title)