End User Certificate Guide by kng16610


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									                                       IMPORT OF SCHEDULED CHEMICALS
                                                                    APPLICATION FORM
1                            DETAILS OF NEW ZEALAND IMPORTER
Name:                                                                                            Email:

Address:                                                                                         Contact Name:

Import agent Name of agent:                                                                      Fax/Email contact address:
details (if
             Contact person:                                                                     Phone:

2                        DETAILS OF OVERSEAS SUPPLIER                                                           NEW ZEALAND END-USER
Name:                                                                          Name:

Physical                                                                       Physical
Address:                                                                       Address:

Country:                                                                       Country:

3          Overseas Port of Loading         Date of arrival into New Zealand        NZ Port where goods are to be unloaded            Total NZ$ value of goods

       Chemical name (as listed on the Chemical Weapons                                         Total mixture       % of chemical within
                                                                                                                                              Country of Manufacture
        Convention Schedules) and trade name if applicable             CAS Number               weight/volume           total mixture

                                                                        End Use of chemical/s

                                      New Zealand Tariff Item number/s (please list in order in which they appear above)

 5 I (Name)                                                                               (Position/Title)
Importer or duly authorised Agent/Manager/Secretary of the above-mentioned Importer hereby apply for permission under Section 10 of the Chemical
Weapons Prohibition Act 1996 to import the goods described above. I hereby declare that the particulars set out above are true and correctly stated in
every respect. I provide assurance that the goods will not be used in any activities related to the development or production of nuclear, chemical or
biological weapons.

Signature:                                                                                           Date:

                                                                 FOR OFFICE USE ONLY
                                                                                Date Application Received:
                  MFA                                                                          Permit Dated:

                                                               I hereby consent to the import of the goods
                                                               described above by the importer named in this
    Expires:                                                   application
                                                                                                                                 Export Control Officer
                                                                                                                       for Secretary of Foreign Affairs and Trade

                                                     Export Controls, Ministry of Foreign Affairs and Trade
                                           Phone (04) 439 8227 Fax (04) 439 8519 Email exportcontrols@mfat.govt.nz
                                                 GUIDE TO COMPLETING THE

• Note:     There is no charge for the issue of an import permit.
  -         Standard processing time is 10 working days.
  -         For further details on the import of scheduled chemicals refer to our website:
• Please provide a completed End User Certificate - Dual Use Goods form with this application (a copy of the End User
  Certificate - Dual Use Goods form is available from the Export Controls website (see link given above).

• The form has been protected so that you can only type in the boxes where information is required. If handwriting, please
  print clearly.
• When completing electronically, start by placing the cursor in the “Phone” box. Type in the contact phone number of the
  applicant or relevant contact person.
• Move through the form by using the TAB key or your mouse.

                                               Please complete all sections 1 – 5
Section 1: New Zealand importer & import agent
• Phone: provide the phone number of the contact person with whom Export Controls can discuss application details, if
  required. Provide this person's name in the Contact Name box.
• Name: provide the name of the company or the private individual importing the goods.
• Provide the street address in the address section (postal addresses are not acceptable here).
• Provide either a fax number or email address to which a completed permit can be sent. If neither is available, please
  attach a covering note indicating where a completed permit can be mailed.
• Import Agent Details (if applicable): an import agent may apply for the permit on behalf of the importer. If this is the case,
  please provide the name of the agent and fax or email contact address in the spaces provided. A copy of the completed
  permit will be provided to the agent as well as the importer.

Section 2: Overseas Supplier & New Zealand End User
• Details of the Overseas Supplier and the (ultimate) New Zealand End-User must be completed. Always use street
  addresses where available.
• The New Zealand end-user may be the same as the importer, or it may be another entity.
• If there is more than one end-user, please provide details on a separate piece of paper.

Section 3: Shipping/freight details - complete all sections
• You must indicate the overseas port where the goods will be loaded for shipping to New Zealand. This may vary
  from the country of the overseas supplier (e.g. you may purchase from a company in Hong Kong but the goods are loaded
  in Kuala Lumpur. In this case enter Kuala Lumpur).
• Include NZ$ value of whole consignment.

Section 4: Description of Goods - complete all sections
• Provide full details of the chemical being imported, including the chemical name, trade name if applicable, the CAS
  (Chemical Abstract System) number, total mixture weight/volume, % of chemical within total mixture, and the country of
  manufacture for each chemical being imported.
• State the end use of the goods in the space provided, e.g. production of paint/resin.
• Provide New Zealand tariff numbers for every item in the consignment. List these in the same order they appear in the
  description lines above.

Section 5:
Add applicant’s name and position or title in the spaces provided, sign and date the form, then forward to Export Controls,
by fax to:   04 439 8519        or email to:                   exportcontrols@mfat.govt.nz
or post to: Export Controls, International Security & Disarmament Division
            Ministry of Foreign Affairs and Trade
            Private Bag 18-901
            Wellington 5045

                                           Export Controls, Ministry of Foreign Affairs and Trade
                                 Phone (04) 439 8227 Fax (04) 439 8519 Email exportcontrols@mfat.govt.nz

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