End User / End Use Certification for Export Orders

Please fill out the below as completely as possible with End User details. If a Distributor/Reseller, or items
are for STOCK and the End User is truly unknown, please list your Company information below.
Company Name:
Company Address
including Country:**

Contact Name:
Telephone/Email:
Distributor/Reseller/STOCK YES NO
**Orders with 2B999 valves going to China, Russia or Venezuela MUST be sent to Trade Compliance for review**
If the End User is known and listed above, please describe the End Use application of the items.
If Distributor/Reseller information is listed above, or the items are for STOCK, please briefly describe the nature
of business and typical applications products are sold into.

Please confirm ALL the following by signature below:

Bray products will not be exported, reexported, transferred, sold, or supplied (directly or indirectly) to Cuba,
N. Korea, Syria, Sudan, Crimea Region of Ukraine (Russian-controlled), Iran, or any restricted country.

9Bray products will not be exported, reexported, transferred, sold, or supplied (directly or indirectly) for use
in activities which involve the development, production, use or stockpiling of nuclear, chemical or biological
weapons or missiles, or their use in any facilities which are engaged in activities relating to such weapons.

9Bray products will not be exported, reexported, transferred, sold, or supplied (directly or indirectly) to any
person, entity, organization or other party identified on the U.S. Consolidated Screening List.

9Prior to the export, reexport, in-country transfer, sell, or supply of any Bray products, all applicable U.S. and
local export control laws and regulations will be adhered to, and any licenses or approvals required by the
U.S. and/or local government will be obtained.

By signing this document, you certify that you have the actual authority to make such representations and
statements on behalf of the Company, assume the responsibility for complying with these obligations, and
agree that Bray International, Inc. is not liable for any inconsistencies, errors, omissions, or
misrepresentation of relevant facts. Please ensure the signed statement appears on company letterhead.

You certify that the above statements are true and correct, by current and best available knowledge.

_________________________________________________ ___________________________________________________
(Sign Name) (Title)

___________________________________________ ___________________________________________
(Print Name) (Company Name)

___________________________________________
(Date)

EMCP.F11, U.S.