End User Certificate - Download Now DOC

							EUC-A To be completed by Exporter (in Singapore)


                                                       END-USER CERTIFICATE
                                                 The Chemical Weapons (Prohibition) Act, Chapter 37B
                                                              To be submitted to
                                              National Authority (Chemical Weapons Convention)
                                                              Singapore Customs
                                         55 Newton Road, #06-02, Revenue House, Singapore 307987

This set of forms may take you 10 minutes to fill in. You will need the following information to fill in the forms:
   Details of Scheduled Chemical(s) to be Exported
   Details of Exporter, Information on the Export and the Unique Reference Number of your Export Permit application
   Details of Importer and Certification by the Government of the Recipient State

Unique Reference Number of Export Permit application:




               (Unique Entity Number of Declaring Agent)                       (Date of Submission: Year/Month/Day)                   (Sequence Number)

Part A-1     Details of Scheduled Chemical to be Exported
Name of Chemical:                                                                                                     Chemical Percentage Purity:

                                                                                                                                                          %
CAS Registry Number:                                                    NA(CWC) Product Code:                         Total Quantity (in kilograms):

                                                                                                                                                       KGM
Harmonized System (HS) Code:




Part A-2     Details of Exporter (in Singapore)
NA(CWC) Licence Number:


                                                                                             Issued on

                                                                                                                            (Year/Month/Day)
                                                                        Contact Person:
Exporter (Company Name and Address):




                                                                        Designation:




                                                                        Tel Number:                                   Fax number:




Company Stamp:                                                          Signature/Date:




Part A-3     Information on the Export
Transport Code (Please tick where applicable):                                  Bill of Lading/Airway Bill Number:

     01 (For Transfer by Sea)                    03 (For Transfer by Road)
     02 (For Transfer by Rail)                   04 (For Transfer by Air)
Final Destination:                                                              Port of Discharge:




SC-A-082 (Ver 2-11/09)
 EUC-B To be completed by Importer/End User in Recipient Country



                                                           END-USER CERTIFICATE
                                                The Chemical Weapons (Prohibition) Act, Chapter 37B
                                                                To be submitted to
                                                National Authority (Chemical Weapons Convention)
                                                                Singapore Customs
                                           55 Newton Road, #06-02, Revenue House, Singapore 307987

Unique Reference Number of Export Permit application (To be completed by the Exporter in Singapore):




               (Unique Entity Number of Declaring Agent)                         Date of Submission: (Year/Month/Day)                  (Sequence Number)
Part B-1       Details of Scheduled Chemical to be Imported
Name of Chemical:


Chemical Percentage Purity:                          CAS Registry Number:                             Total Quantity (in kilograms):

                                               %                                                                                                       KGM
Part B-2       Particulars of Importer, End User(s) for the Scheduled Chemical
Importer (Company Name & Address):                                                                    Contact Person:




Tel Number:                                          Fax Number:                                      Designation:

Actual End User(s) of the Scheduled Chemical:
       Table 1A
                                                                                   Tel Number,
       Company Name & Address                                                                         End Use(s) of Scheduled Chemical
                                                                                   Fax Number




                                           Total Number of End User(s):                                     Please tick if more information is to
                                                                                                            provided on Table 1B.


I / We, representing           _____________________________________________________________________ hereby certify that:
                                                                    (Name of Company)

i)       The Company / Organisation shall not export, re-sell or dispose any amount of the scheduled chemical declared in Part B-1 outside the
         territory in the Receipient State or to any other person, natural or legal.

ii)      All the information provided in this End User Certificate are true and correct.

iii)     I / We shall update the information of the Actual End User in the event of any addition of End User(s) through my Singapore exporter, to
         the Office of the National Authority (Chemical Weapons Convention), Singapore.

Signature of Importer/Date:                                                     Company Stamp:


Name of Importer:


Part B-3       Certification by the Government of the Recipient State
Name of Government Official:


Department Name & Address:                           Designation:


                                                     Tel Number:                                      Fax Number:


It is hereby certified that the transferred Scheduled Chemical declared in Part B-1:

i)       Shall be used only for the purpose(s) not prohibited under the Convention on the Prohibition of the Development, Stockpiling and Use of
         Chemical Weapons and on their desctruction.

ii)      Shall not be re-transferred or re-exported to other states.
Signature of Government Official / Date:                                                              Department Stamp




                                                                                                                                         Page ___ of ___
SC-A-082 (Ver 2-11/09)
Additional Information to be completed when necessary (continued from Table 1A)


                                                         END-USER CERTIFICATE
                                              The Chemical Weapons (Prohibition) Act, Chapter 37B
                                                              To be submitted to
                                              National Authority (Chemical Weapons Convention)
                                                              Singapore Customs
                                         55 Newton Road, #06-02, Revenue House, Singapore 307987

Unique Reference Number of the Export Permit application (To be completed by the Exporter in Singapore) :




             (Unique Entity Number of declaring agent)                        Date of Submission: (Year/Month/Day)          (Sequence Number)
Actual End User of the Scheduled Chemical (continued from Table 1A):

    Table 1B
                                                                               Tel Number,
    Company Name & Address                                                                          End Use(s) of Scheduled Chemical
                                                                               Fax Number




                                         Total Number of End User(s):


                                                                                                                              Page ___ of ___


SC-A-082 (Ver 2-11/09)