End User Certification for Exported Goods

In accordance with United States export laws, it is the policy of Pine Research Instrumentation to verify the end-use, end-user, and intermediate entities for all exported shipments of our products, related technology, and software. We require obtaining a completed End-User/End-User Certificate (EUC) and store the certificate on file, which is necessary to release an exported order for shipment. Contact Pine Research Instrumentation if you have any questions about completing this form. Exported orders will not be processed or shipped until we have received this completed form.

All orders from Pine Research Instrumentation that are destined to be exported for use outside of the United States requires that the parties involved (end-user, intermediate consignee, and ultimate consignee) disclose the parties involved in the transaction. By signing this form, parties acknowledge having read and understood export restrictions and requirements.

"*" indicates required fields

Exports Compliance Statement

Please carefully read this statement. Acknowledge you have read and understood the statment below to proceed.

Will not be imported, re-exported or transferred to be used in the design, development, production, stockpiling, or use of chemical or biological weapons and their precursors.
Will not be imported, re-exported or transferred to be used in the design, development, production, stockpiling, or use of missiles, rocket systems or unmanned air vehicles of any range or payload. “Rocket systems” include, but are not limited to, ballistic missile systems, space launch vehicles, and sounding rockets. “Unmanned air vehicles” include, but are not limited to, cruise missile systems, target drones and reconnaissance drones.
Product and/or replicas ("replicas" refers to items produced abroad on physical examination of the item originally exported, matching it in all critical design and performance parameters) thereof will not be used (either directly or indirectly) in sensitive nuclear end-uses, as follows:
1. Nuclear explosive activities: Nuclear explosive activities, including research on or development, design, manufacture, construction, testing or maintenance of any nuclear explosive device, or components or subsystems of such a device.
2. Unsafeguarded nuclear activities: Activities including research on or development, design, manufacture construction, operation, or maintenance of any nuclear reactor, critical facility, facility for the fabrication of nuclear fuel, facility for the conversion of nuclear material from one chemical form to another, or separate storage installation, where there is no obligation to accept International Atomic Energy Agency (IAEA) safeguards at the relevant facility or installation when it contains any source or special fissionable material (regardless of whether or not it contains such material at the time of export), or where any such obligation is not met.
3. Safeguarded and unsafeguarded nuclear activities: Safeguarded and unsafeguarded nuclear fuel cycle activities, including research on or development, design, manufacture, construction, operation or maintenance of any of the following facilities, or components for such facilities for the:
  1. Facilities for the chemical processing of irradiated special nuclear or source material;
  2. Facilities for the production of heavy water;
  3. Facilities for the separation of isotopes of source and special nuclear material; or
  4. Facilities for the fabrication of nuclear reactor fuel containing plutonium.
The goods will not be imported, re-exported or transferred to be used in the design, development, production, construction, support, or maintenance of a maritime nuclear propulsion project; including any machinery, devices, components or equipment specifically developed or designed for use in such plants or facilities.
Will not be imported, re-exported or transferred to be used in crime control and detection commodities and end-uses.
Will not be imported, re-exported or transferred to destinations embargoed by the U.S. government (unless deminimus provisions apply).
Will not be imported, re-exported or transferred to entities listed on U.S. government denial lists: U.S. Department of Commerce Denied Persons List, Treasury Department Specially Designated Nationals and Blocked Persons Lists, State Department Debarment List, and State Department Parties of Proliferation Concern.
Will not be imported, re-exported or transfered for use by the end-users listed on the Entity List, Supplement No. 4, Part 744 of the EAR without approval from the U.S. Department of Commerce or the Pine Instrument Company International Dept.
Will not be imported, re-exported or transferred to be used by persons on the Unverified List as published by the U.S. Department of Commerce Bureau of Industry and Security.
Written Authorization will be obtained from the Bureau of Industry and Security prior to re-exporting the items or technology, unless they would be eligible for export from the United States to the new country of destination under U.S. export law.
Will not be used, sold, resold, delivered or transferred, directly or indirectly, contrary to U.S. export regulations.
Will not be imported or re-exported for use by or for by persons who commit, threaten to commit or support terrorism. The term terrorism means an activity that:
1. Involves a violent act or an act dangerous to human life, property, or infrastructure; and
2. Appears to be intended:
  1. to intimidate or coerce a civilian population;
  2. to influence the policy of a government by intimidation or coercion; or
  3. to affect the conduct of a government by mass destruction, assassination, kidnapping or hostage taking.

Order Identification and Use/Application

Order/Reference Number*

Please enter the order or reference number associated with this purchase (i.e., the import). This may be a purchase order number, a quote number, or another reference number provided by a reseller.

Product Use/Application Description:*

Describe the anticipated use and application of the product(s) purchased. Please be fairly specific. A statement such as "for use in a laboratory" or "for R&D purposes" are not sufficiently specific.

Import/Export/Purchasing Scenario

The selection you choose informs the rest of the End User Certificate form. Choose the option that aligns with your purchasing scenario. If you are unsure or have questions, please Contact Us.

Please indicate who you are (what party) in this scenario:

End-User (ultimate user of products, purchasing directly from Pine Research)

Reseller (purchasing from Pine Research and selling to End-User)

Third Party (when two different resellers are involved in a sale to the End-User)

End-User Details

The End-User is the person who will actually be using the products (e.g., researcher, scientist, student, etc.) and must be accurately identified for any scenario. The exports term for the End-User is Ultimate Consignee.

Name*

First Last

Organization Name*

with what organization (e.g., company or academic institution) are you affiliated?

End-User Complete Address*

This should be the physical address of where the End-User intends to use the imported good(s).

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reseller Details

The Reseller purchases the goods for import from Pine Research and then sells them to the End-User. The exports term for this intermediate party is Intermediate Consignee.

Name*

First Last

Organization Name*

with what organization (e.g., company) are you affiliated?

Reseller Complete Address*

This should be the physical business address of the Reseller (e.g., their company address).

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code Country

Third-Party Agent Details

The Third Party Agent purchases the goods for import from another reseller, the Intermediate Party. The Third Party Agent then sells the goods to the End-User. The exports term for this Third-Party Agent is Additional Consignee.

Name*

First Last

Organization Name*

with what company or academic institution are you affiliated?

Third-Party Agent Complete Address*

This should be the physical business address of the Third-Party Agent (e.g., their company address).

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Export/Import/Purchasing Scenario Confirmation

Certification Section

Any person party to this transaction can complete and sign the form, however the person signing acknowledges the export laws, rules, and regulations stated above. The person completing this form should enter their details in this section. You must complete the fields, even if the person completing the form is one of the parties listed above. We will contact this person with any questions about their EUC submission.

Name*

First Last

Email Address*

Enter Email Confirm Email

Title or Role*

Please provide your organizational title or role.

Signature*

Date*

Comments

This field is for validation purposes and should be left unchanged.

Exports Compliance Statement

Order Identification and Use/Application

Import/Export/Purchasing Scenario

End-User Details

Reseller Details

Third-Party Agent Details

Export/Import/Purchasing Scenario Confirmation

Certification Section

About You

Billing Address

Credentials

End User Certification for Exported Goods

Exports Compliance Statement

Order Identification and Use/Application

Import/Export/Purchasing Scenario

End-User Details

Reseller Details

Third-Party Agent Details

Export/Import/Purchasing Scenario Confirmation

Certification Section

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