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This is an example of end user certificate. This document is useful for conducting end user certificate.
Date: To: Hypertronics Corp. 16 Brent Drive Hudson, MA 01749-2978 Attn: From: ____________________ Telephone Number: ____________________ Email: _________________________________ Re: End User Certificate for , PO # 1. This certificate is appropriate to products, components, and/or equipment (referred to as “items”) subject to EAR99 requests. 2. We _________________________________ complete name and address have ordered the items attached. 3. We certify that the items (check the box(es) that apply): [ ] Will be used by us as capital equipment. [ ] Will be processed by us into products. [ ] Will be resold by us in the form in which it was received. [ ] Other 4. We declare that the items (in the form received and/or incorporated into other products) will not be destined to any embargo countries according to the EAR part 746 and any applicable US Department of Treasury regulations (31 CFR part 500 et. seq.). 5. The items above will not be used for any purposes connected with chemical or biological or nuclear weapons, irradiated special nuclear or source material, heavy water production, separation of isotopes of source and special nuclear material, or fabrication of nuclear reactor fuel containing plutonium, or unsafeguarded nuclear facilities, or missiles (including rocket systems and unmanned air vehicle systems), nor will they be resold if we know or suspect that they are intended or likely to be for such purposes. Sincerely, Form F679 Rev. A 5/9/08
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