This EUS form and Annex A must be provided when you order goods that are to be used by you, whether shipped via a separate consignee or not. Both documents must be completed on your company’s letterhead. Please note that if you are an individual, these documents do not have to be on letterhead.
Please read the following explanation of terminology carefully for guidance on completing the EUS form.
- The Kosovo licensee is the person or entity who is either exporting the goods abroad or brokering the movement of the goods concerned, each of which may be shipped directly to you or via a separate consignee.
- If unknown, the licensee’s reference can be left blank for completion by the licensee.
- The consignee is the person or body who is the first recipient of the goods. This can be yourselves or it can be another person or body within your country or in another country. If you are both the consignee and the end-user, then you must enter your own details in boxes (c) and (d).
- As the end-user, you will receive the goods for end-use, so boxes (e) and (f) must be completed. If you incorporate the goods into another product or higher-level system, then you are still the end-user for the purposes of the movement of the items.
- The end-user in this box refers to the entity at the time of shipment.
- The goods in this box refer to those at the time of shipment.Note: If goods are to be incorporated into another product or higher-level system, then this information should be included in Section 3.
- The Kosovo authorities must be able to understand what the goods are, and so a detailed description of the main item or items is required. If, for example, the main item or items are accompanied by a long list of spares, components, or accessories, you should also indicate this in Section 2.
- If the goods are to be “incorporated” by you (installed into another product or higher-level system) then that product/higher-level system, its use, and ultimate end-user (which may be within or outside your destination) should be described, if known, in Section 3.
- Section 4 must be signed and dated by you as the end-user since you will use the goods identified in Section 2. This includes cases in which you incorporate the goods into another product or higher- level system. This section should be signed and dated by a person within your organization with authority to sign on behalf of the company/organization. Digital signatures are not acceptable.
END-USER STATEMENT (EUS) FORM
SECTION 1 – PARTIES
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(b) Licensee’s Address 2 |
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(c) Name of Consignee 3
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(d) Consignee’s Address |
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(e) Name of End-User 4
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(f) End-User’s Address |
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(g) Is the end-user the armed forces or internal security forces of the country? 5
Please DELETE an option: Yes/ No |
(h) Specific location where goods will be used or based (if known) and if different from (f) 6
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SECTION 2 – GOODS
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(for consumable goods, include length of time supplies are expected to last) |
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(If you need to use continuation sheets, each must carry the licensee’s reference, and must be signed and dated by the same person who signs this form.) |
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SECTION 3 – END-USE OF THE GOODS
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Please set out the specific purposes for which the goods are to be used by the end-user (including, if applicable, where the goods are being incorporated) 8
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SECTION 4 – END-USER UNDERTAKING 9 (to be completed by the person or body named in 1(e) and 1(f))
We – the person or body named in 1(e) and 1(f) – certify that we are the end-user of the goods described in Section 2, which are to be supplied by the licensee named in 1(a). We further certify: that we shall use the goods for the purposes described in Section 3; that the goods will not be used for any purpose connected with chemical, biological, or nuclear weapons, or their means of delivery; that they will not be re-exported or otherwise re-sold or transferred if it is known or suspected that they are intended or likely to be used for such purposes; that the goods will not be re-exported or otherwise re-sold or transferred to a destination subject to UN, EU, or OSCE embargo where that act would be in breach of the terms of that embargo;10 and that the goods, or any replica of them, will not be used in any nuclear explosive activityi or unsafeguarded nuclear fuel cycle.ii
Sign here _____________________________ Date ___________________
(Signature of official of end-user)
Print name __________________________________________
(Add name of signatory in capital letters)
Role ____
(Add job title of signatory in capital letters)
Note
i Includes research on or development, design, manufacture, construction, testing, or maintenance of any nuclear explosive device or components of subsystems of such a device.
ii Includes research on or development, design, manufacture, construction, operation, or maintenance of any reactor, critical facility, conversion plant, fabrication plant, reprocessing plant, plant for the separation of isotopes of source or special fissionable material, or separate storage installation, where there is no obligation to accept IAEA safeguards at the relevant facility or installation, existing or future, when it contains any source or special fissionable material; or of any heavy water production plant where there is no obligation to accept IAEA safeguards on any nuclear material produced by or used in connection with any heavy water produced therefrom; or where any such obligation is not met.
ANNEX A TO EUS FORM
Model cover letter for end-user statement [to be amended where indicated]
[NAME AND ADDRESS OF END-USER ON THEIR ORIGINAL LETTERHEAD]
[DATE]
End-user statement relating to the Kosovo license application made by [STATE NAME OF LICENSEE]
I attach a completed end-user statement made on the EUS Form.
Yours sincerely,
[TO BE SIGNED BY THE SAME SIGNATORY WHO COMPLETED AND SIGNED THE END- USER STATEMENT (EUS) FORM, TOGETHER WITH THEIR ROLE]