END USE CUM END USER CERTIFICATE IN CASE OF EXPORT OF CHEMICALS

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....nd-User _________________________________________________________ (g) End-User's Address _________________________________________________________ (h) Specific Location where the items will be used (if different from (g))_________________________________ PART 2: ITEMS    (a) Description of the item(s) (e.g. Purity/Concentration, IUPAC Name & CAS number  (b) Quantity/Weight             (c) Purchase order Number & Date of signature of contract  ________________________________________________                           &....

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....on (CWC). e) I/we also certify that all the facts contained in this certificate are true and correct to the best of my knowledge and belief and that I/we do not know of any additional facts that are inconsistent with this certificate. Signature:    _____________________________                     Date: ________________                                  (Signature of authorised signatory)   Name:        ____________....