Military Fuses/Goods export form

Military parts require this form filled out and approved, before orders on these parts can be ordered and confirmed. The approval  process by the regulations can take a few month. Do not enquire, if you not accept this.

ML Goods Undertaking Template  (please copy and paste onto your official headed paper)

We:

[PLEASE COMPLETE WITH YOUR COMPANY DETAILS]
Certify that the goods shown below have been ordered by us from:

COOPER BUSSMANN UK LTD
MELTON ROAD, BURTON-ON-THE-WOLDS
LEICESTERSHIRE
LE125TH
UNITED KINGDOM

The goods to be supplied are:

[PLEASE PROVIDE TE FULL DESCRIPTION OF THE GOODS]

Part No:     [PLEASE COMPLETE]
Quantity:     [PLEASE COMPLETE]

This relates to the [CUSTOMER] Purchase Order Number:  [PLEASE COMPLETE]

And are for the following purpose(s):

These parts to be incorporated into the [PLEASE COMPLETE ACCORDINGLY and include the ]. This incorporation will take place by [PLEASE COMPLETE AT NAMED PLACE] for onward supply to [PLEASE ADD THE PARTY  AND NAMED PLACE THAT APPLY].

And are for delivery to the following addresses
[ADD CUSTOMER  ADDRESS]

SELECT ONE OF THE BELOW FOR ML GOODS YOU MUST SELECT ONE FROM THE BELOW…

*I/We also certify that the goods, software or technology above are for *my/our own use, and will not be re-exported or sold for export either in their current state or after incorporation.
Or

(ii)    *I/We also certify that the goods, software or technology above are for end-use1 in one or more of the following countries, either in their current state or after incorporation:

[Delete countries below as appropriate]

Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland (Republic of), Italy, Japan, Netherlands, New Zealand, Norway, Spain, Sweden, United Kingdom, USA

Or

(iii)    *I/We also certify that the goods, software or technology above are for re-export, either in their current state or after incorporation, for the end-use of the Government of the following countries, or a NATO organisation in one of those countries:

[Delete countries below as appropriate]

Bulgaria, Cyprus, Czech Republic, Estonia, Greece, Hungary, Latvia, Lithuania, Luxembourg, Malta, Poland, Portugal, Romania, Slovakia, Slovenia, Switzerland (including Liechtenstein)

Or
(iv)     *I/We also certify that the goods, software or technology above are for export to, and for the sole use of the [          ] armed forces deployed in [          ].
Or:
(v)    *I/We certify that the goods, software or technology above are for use by the [          ] Government, including use by its own armed forces deployed in any destination except an arms embargoed destination

We confirm that the goods above will not be used for purposes associated with chemical, biological or nuclear weapons or missiles capable of delivering such weapons, nor will they be resold if we know or suspect that /they are intended or likely to be used for such a purpose

We confirm 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;

We confirm that the goods, or any replica of them, will not be used in any nuclear explosive activity  or unsafeguarded nuclear fuel cycle.

Signed……………………………………………
Name……………………………………………..
(BLOCK CAPITALS)
Status……………………………………………..
Date………………………………………………