COMMERCIAL END-USE/END-USER CERTIFICATION

FORM No. SALES025 Rev. D Revised: 2/22/2016

Page 1 of 1

The following information shall be treated as confidential and is reserved for the purpose of determining
export licensing requirements only. Nasco Aircraft Brake, Inc will not directly solicit any identified end users
and/or party to this transaction for a period of two (2) years after receipt of this signed document.

Contract Number (if any): _______________________________________________________________

Country of Ultimate End Use: ____________________________________________________________

Application: Commercial / Civil Military Scientific Nuclear Military

Satellite Commercial / Scientific Satellite Chemical / Biological
Missiles / Space (including Unmanned Air Vehicles)

End-Use:_____________________________________________________________________________
_____________________________________________________________________________________
Note: Identify the specific details for which the good(s)/item(s), including any related software and technology, will be used.
Provide adequate information so that the end-use can be confirmed, e.g., manufacturer, application / program name,
satellite name, name of nuclear facility, name of foreign manufacturer, model number of aircraft/vehicle model,
specific purpose and function.
End-User: Identify all known parties to the transaction (use continuation sheet if necessary)

Name and Address of Domestic and/or Foreign Ultimate End User:

Note: Identify the ultimate end-user(s) of the items being exported, e.g., government entity / entities to include identification
of specific military department or agency, commercial/civil, scientific, nuclear end user. Include full name, address
and telephone number. A physical address is required. A post office box cannot be used.
Name and Address of Foreign Consignee (If domestic state “domestic use only”):

Note: Complete name, address and telephone number of the purchaser. This may be the same as the End User. A post
office box cannot be used.
Name and Address of Foreign Intermediate Consignee (If domestic state “domestic use only”):

Note: Complete name and address of agent or representative or any other entity receiving the
good(s)/item(s) prior to delivery to the foreign consignee and/or the end user.

Certification: (1) I am authorized to legally bind the company, and (2) I understand that the exported
good(s)/items(s) including related software and technology cannot be transferred, transshipped, or
otherwise disposed of in any manner other than that specified herein without the prior written approval of
Nasco Aircraft Brake, Inc. or the U.S. Government, and (3) I hereby certify that the above is true and
accurate, and (4) I also certify that the good(s)/item(s) and related software and technology will not be used
for military purposes or proliferation of nuclear, biological, and/or chemical weaponry unless specifically
stated herein, and (5) I further certify that NO aircraft parts or components purchased from Nasco Aircraft
Brake, Inc may be exported to North Korea, Sudan, Syria, or countries subject to U.S. sanctions (including,
but not limited to Iran, Cuba, and persons or organizations designated as terrorists, drug traffickers,
weapons proliferators), and (6) that I certify that our company will comply with the laws set-forth in the
Export Administration Regulations (“EAR”), http//www.bis.gov.

Company Name: _______________________________________________________________________

Signature: ____________________________________ Printed Name: ________________________

Title: ________________________________________ Date: _______________________________