[Insert Company Letterhead here]

End Use/User Statement

Our organization intends to purchase for our use a product to be supplied by you, Thermo Fisher*, or by a party who has initially
purchased the product from you for resale. We understand that delivery of the product may take place only after Thermo Fisher* has
received specific information regarding our intended end use of the product. This information is needed to help assure compliance
with the export laws of various countries, such as the United States and other countries, which apply to export of the product and to
its use. Accordingly, we certify as follows:
Thermo Fisher product(s) we wish to purchase:

End User Name and Address

End Use of product(s) to be purchased (Be specific)

We certify that to the best of our knowledge the above is correct and true, and that we will not use the product in the development,
design, manufacture, construction, testing, or maintenance of nuclear explosive devices, missiles, or chemical or biological weapons.
In addition, we agree that we will not re-export or transfer the product, or permit its re-export or transfer, to Cuba, Iran, North Korea,
Sudan, or Syria or to any country or person for which government authorization would be required. We agree to promptly notify
Thermo Fisher of any change in our end use or in the location at which the product is used.

Sincerely,

(Signature of authorized official) (Date)

(Typed or printed name of official) (Company name)

(Title of official) (email address)

(phone number)

*Thermo Fisher is used in this letter to refer to the business unit of Thermo Fisher Scientific Inc. who will supply a product.