This stockist end-user statement (SEUS) form and Annex A must be provided when you order goods which you intend to hold in stock, whether shipped via a separate consignee or not. Both documents must be completed on your company’s letterhead. 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 SEUS form.
- The Kosovo licensee is the person or body 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 another person or body within your country or in another country. If you are both the consignee and the stockist end-user, then you must enter your own details in boxes (c) and (d).
- As a stockist end-user you will be receiving the goods to be held in stock for onward shipment within or outside your country in the future, so boxes (e) and (f) must be completed.
- This box refers to those occasions in which the goods are to be supplied in the future rather than at the time of shipment.
- The goods in this box refer to those at the time of shipment.
- 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.
- Section 3 must be signed and dated by you as the stockist end-user, since you will hold in stock the goods identified in Section 2. Either (i) or (ii) of Section 3 must also be completed, as applicable. 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.
Note: When you should use the stockist end-user statement (SEUS) form
This form should only be completed if the goods are going into your stock for delivery elsewhere in the future. Even if you know your customer at the time of placing your order, but are holding the goods in stock against future orders they place with you, you should still submit the SEUS and complete Section 3(ii) accordingly.
However, if you know, at the time of placing your order with the Kosovo licensee that, upon receipt of the goods, you will supply them right away to a named entity elsewhere, you should not complete this SEUS. Instead, you should ask your customer to complete the end-user statement (EUS) form, a copy of which should be available from your Kosovo licensee or at Guidance for End-Users to Complete the EUS Template and Cover Letter.
STOCKIST END-USER STATEMENT FORM
SECTION 1 – PARTIES
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(a) Name of Kosovo Licensee 1
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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 Stockist End-User 4
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(f) Stockist End-User’s Address |
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(g) Are the goods ultimately intended for the armed forces or internal security forces of the country? 5
Please DELETE an option: Yes/No
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(h) Specific location where goods will be held in stock (if known) and if different from (f) 6
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SECTION 2 – GOODS
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(a) Quantity of Goods |
(b) Description of the Goods 7 (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 – STOCKIST END-USER STATEMENT8 (to be completed by the person or body named in 1(e) and 1(f))
We – the person or entity named in 1(e) and 1(f) – certify that we are the importer of the goods described in Section 2, and we further certify that the goods are intended for stock to be held against future orders and EITHER (delete one of (i) or (ii) below)
i will not be re-exported, sold for export or otherwise transferred from the country where we are based, namely:
OR
ii are likely to be transferred to the following countries and/or customers:
We further certify: that we will not supply the goods to an entity in the future if we know or suspect that they are intended or likely to be used for any purpose connected with chemical, biological, or nuclear weapons, or their means of delivery; that we will not supply the goods to an entity in the future in a destination subject to UN, EU, or OSCE embargo where that act would be in breach of the terms of that embargo;9 and that we will not supply the goods or any replica of them in the future, if we know or suspect that they are intended or likely to be used in any nuclear explosive activityi or unsafeguarded nuclear fuel cycle.ii
Sign Here _____________________________ Date ________________
(Signature of Official of Stockist)
Print Name _____________________________
(Add Name of Signatory in Capitals)
Role _____________________________
(Add Job Title of Signatory in Capitals)
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 STOCKIST END-USER STATEMENT FORM
Model cover letter for Stockist End-User Statement
[to be amended where indicated]
[NAME AND ADDRESS OF STOCKIST END-USER ON THEIR ORIGINAL LETTERHEAD]
[DATE]
Stockist End-User Statement relating to the Kosovo license application made by [STATE NAME OF LICENSEE]
I attach a completed stockist statement made on the SEUS Form.
Yours sincerely,
[TO BE SIGNED BY THE SAME SIGNATORY WHO COMPLETED AND SIGNED THE STOCKIST END-USER STATEMENT (SEUS) FORM, TOGETHER WITH THEIR ROLE]