Request for Annual Certification to Travel with UML Issued Laptop
This form is used when UML faculty or staff travel internationally for research or University-related activities that involve hand carrying electronic equipment such as laptops, PDAs, smart phones, etc. Most computers are allowed to be temporarily exported in this manner to most locations under the TMP license exception provision of the Export Administration Regulations. Complete the information below andsubmit to Institutional Compliance at or Thomas_ .
Section A – General Information
PI Name: Click here to enter text.
Department: Click here to enter text.
Contact Information (office address, phone, and email): Click here to enter text.
Describe the type of computer or electronic equipment (include make and model):Click here to enter text.
Describe how the equipment will be used during travel:Click here to enter text.
Estimated net market value of items in U.S. Dollars: $Click here to enter text.
Section B – Assurance Statement
Note: All boxes must be checked and verified for letter to be issued.
I understand and verify the following statements to be true:
☐ The TMP exception is for travel with my UML issued computer or electronic equipment with the intent that the items will be under my control while out of the U.S. and the equipment will return with me to the U.S.
☐ I do not have any controlled information or technical data on any of the devices.
☐ The item to be taken or shipped outside the borders of the United States does not include encryption source code or software (other than the typical operating system software).
☐ The item to be taken or shipped will be used to carry out research or support teaching activities in other than an embargoed, sanctioned, or prohibited country.
☐ The shipments of any other physical items or chemical or biological materials will conform to all applicable laws governing their handling and may require additional documentation and/or a license to export.
☐ The University's Director of Institutional Compliance will be notified of the person(s) and place(s) to be visited in advance of travel to any country inGroup D or Ein order to conduct an end-user screen for specific persons or entities subject to export prohibitions.
☐ Check here to indicate this form was submitted from your email account.
If not submitted electronically, please sign below to indicate verification of the above statements.
Signature:
Section C – Compliance Office Use Only
Approved by Name:Choose an item. Date:Click here to enter a date.
Other Action: Click here to enter text.
Req Annual Cert Travel UML Issued Laptop rev 07-06-12.docx