Singapore End User Statement Form by rrn51447


Director-General, Singapore Customs
Attn: Trade Control Branch
Fax: 6254 4043
                                               END-USER STATEMENT

I/we, (name, address, and e-mail address of end-user)

Phone Number: __________________________ Fax Number: _________________________

I have requested Schenker Singapore Pte Ltd, No. 51Alps Avenue, Level 5 Singapore 498783, Attn: Cisco
Support, Logistics Operations
to export:
                                        1                           2                            3
Product Description      Find in Trade Tool, top blue                            e.g. Preloaded Software for
                         bar, e.g. 3845 Voice                                    items 1 and 2 Cisco 3845 IOS
                         Bundle,PVDM2-64,SP                                      SP SERVICES
Category Code            ECCN# xxxx (e.g. 5A002)                                 ECCN# xxxx (e.g. 5D002)
HS Code                  (Find in Trade Tool, US HTS                             n/a
Brand                    Cisco                                                   Cisco
Model                    (Find in Hold Report, item,                             S384SPSK9-12311T
                         e.g. CISCO3845-V/K9)
Type                     (e.g. Cisco 3845)                                       Cisco Software
Quantity                 (Find in Status Tool)                                   2
Value                    (Find in Status Tool)           USD 9,097.00            See items 1 and 2
Sales Order              (Find in Hold Report)           9352527                 9352527
Ship Set                 (Find in Hold Report, verify in 23                      20, 23
                         Status Tool)

which is intended for INTERNAL IT USE,
(provide specific detailed end-use of the goods identifying the specific operations to be performed by the goods in support
of the end-user’s business activities)

in (Country of ultimate destination)

I/we confirm that the goods will not be used in relation to nuclear, biological or chemical weapons, or missiles capable of
delivering these weapons. I/we also confirm that the goods will not be re-exported or sold to a third party.
Name (in block letters): _______________________________________________________
Designation: ______________________
Date : ______________________
Authorized Signature : ___________________________ Company Stamp

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