SECTION 1 – PARTIES
(a) Name of UK Exporter 1
The Warefield Engineering Limited
38 Johnson Road, Heston
Middlesex, TW5 9LJ, UK
(b) Exporter’s Reference 2
(c) Name of Consignee 3
(d) Consignee’s Address
(e) Name of End-User 4
(f) End-User’s Address
(g) Is end-user the armed forces or internal security forces of the country?
Please DELETE an option:
Yes / No
(h) Specific location where goods will be used or based (if known) and if different
from (f)
SECTION 2 – GOODS
(a) Quantity of Goods
(b) Description of the Goods 5
(for consumable goods, include length of time supplies are expected to last)
(If you need to use continuation sheets, each must carry the exporter’s reference,
and must be signed and dated by the same person who signs this form.)
Sign Here _____________________________ Date ________________
(Signature of official of end-user or consignee)
SECTION 3 – END-USE OF THE GOODS
Please set out the specific purposes for which the goods are to be used by the end-user/consignee
6
SECTION 4 – END-USER UNDERTAKING 7
We – the person or body named at 1(e) – certify that we are the end-user of the goods
described in Section 2, which are to be supplied by the exporter 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 missiles capable of delivering such weapons; 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
8; and that the goods, or any replica of them, will not be used in any nuclear explosive
activity i or unsafeguarded nuclear fuel cycle ii.
Sign Here _____________________________ Date ________________
(Signature of official end-user)
Print Name _____________________________
(Name and Job Title of signatory in Capitals)
SECTION 5 – CONSIGNEE UNDERTAKING (to be completed if Section 4 is NOT signed) 9
We – the person or body named at 1(c) – certify that we are the importer of the goods
described in Section 2. We further certify that the goods are intended for stock
to be held against future orders and EITHER (delete one out of (i) or (ii)
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: ________________
Sign Here _____________________________ Date ________________
(Signature of Official Consignee)
Print Name _____________________________
and Role (Name and Job Title of signatory in Capitals)
Sign Here _____________________________ Date ________________
(Signature of official of end-user or consignee)
Annex A to EUU Form
THIS IS AN EXAMPLE
Please print on your original headed paper.
[Fill in the red bits where these brackets are shown]
Model covering letter for end-user undertaking
[NAME AND ADDRESS OF END USER ON THEIR ORIGINAL HEADED PAPER]
[DATE]
End use undertaking relating to the UK export licence application made by [NAME OF
EXPORTER]
I attach a completed end-user undertaking made on the EUU Form relating to Exporter’s
Reference …………. [EXPORTER’S REFERENCE AT 1b OF THE END-USER UNDERTAKING (EUU) FORM
MUST BE QUOTED]
Yours sincerely
[SIGNED BY THE SAME SIGNATORY WHO COMPLETED AND
SIGNED THE END-USER UNDERTAKING (EUU) FORM]
END