(MUST BE ON END USER’S COMPANY LETTERHEAD)

Note: Please Read.

Do not complete this form if parts are specifically designed, developed, configured, adapted, or modified for a military, missile, satellite, or other controlled use listed on the United States Munitions List (USML) including component parts of items listed. See the USML at U. S. Code of Federal Regulations (CFR) Title 22, subchapter M, part 121. The USML lists articles, services and technical data designated as being related to defense.

If the above statement applies to the parts you are purchasing from Tech-Etch, ask your customer service representative for an International Traffic in Arms Regulations (ITAR) End Use Statement.

Use this form only for “Dual Use” items (defined as having both military and commercial applications) or “Commercial” items (defined as having no military application).

END-USE STATEMENT

The following products:

Item Number	Description	Product Type [RFI/EMI], [Photo-Etch] or [Flex Circuit]	Enter: [Commercial] or [Dual Use]	Part Number
1
2
3

will be used at STATE END USER NAME HERE.

Specifically, the parts will be used to: STATE SPECIFIC END USE INCLUDING THE SPECIFIC END PRODUCT THE PARTS WILL BE INSTALLED ON OR IN.

The ultimate consignee STATE END USER NAME HERE is located at STATE PHYSICAL ADDRESS HERE.

STATE END USER NAME HERE certifies that it will not use these or any other Tech Etch, Inc. products in research on, or the development, design, manufacture, construction, testing or maintenance of, nuclear explosive devices, or components or subsystems of such a device; in “unsafeguarded nuclear activities” or in unsafeguarded or safeguarded nuclear fuel cycle activities; the design, development, production or use of missiles; the design, development, production or use of rocket systems (including ballistic missile systems and space launch vehicles and sounding rockets); the design, development, production or use of unmanned air vehicles (including cruise missile systems, target drones and reconnaissance drones); or the design, development, production, stockpiling or use of chemical or biological weapons.

We certify that all of the facts contained in this statement are true and correct to the best of our knowledge, and we do not know of any additional facts that are inconsistent with the above statements. We shall promptly send a replacement certification to Tech-Etch, Inc. disclosing any material change of facts or intentions described in this certification that occur after this certification is prepared and forwarded to Tech-Etch, Inc.

Except as specifically authorized by the U.S. Export Administration Regulations, or by written approval from the U.S. Department of Commerce, Bureau of Industry and Security, we will not retransfer, reexport, resell, or otherwise dispose of any items whose export is supported by this certification:

to any country not approved for export as brought to our attention by Tech-Etch, Inc.; or

to any person if there is a reason to believe that it will result directly or indirectly in disposition of the items contrary to the representations made in this certification or contrary to the U.S. Export Administration Regulations.

__________________________	__________________________

Company Name	Date

___________________________	__________________________

Responsible Official’s Full Name (print)	Position

___________________________

Responsible Official’s Signature

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.

Safeguarded and unsafeguarded nuclear fuel cycle activities include research on or development, design, manufacture, construction, operation or maintenance of any of the following facilities, or components for such facilities:

(i) Facilities for the chemical processing of irradiated special nuclear or source material;

(ii) Facilities for the production of heavy water;

(iii) Facilities for the separation of isotopes of source and special nuclear material; or

(iv) Facilities for the fabrication of nuclear reactor fuel containing plutonium.