Please return this document filled-in, duly signed and stamped to GenMar LATAM
Email to: soporte@[Link]
End Use/End User Certificate
The Business Partner hereby acknowledges that furnished products might be subject to various Export
Regulations (e.g. stipulated by the United Nations (UN), the European Union (EU), the United States of
America (US) and other potentially applicable export control laws referred to therein, including without
limitation Embargo and Sanctions Regulations, e.g. issued by UN, EU, US, etc.
The Business Partner agrees and expressly certifies that neither itself nor its agents, representatives or
employees, will cause or facilitate the resale, export, re-export or servicing of supplied
goods/technology/software, directly or indirectly through a third- party contrary to applicable Export
Regulations. It will fully comply with the applicable regulations and obtain all authorizations in writing from
the respective authorities in charge.
Especially, the Business Partner confirms that it will not perform any of the above actions to individuals or
entities or countries for which an embargo is applicable to the specific transaction, e.g. maintained by the
UN, EU, US, etc. OR which are listed on applicable Denied Person’s Lists issued by the UN, EU, US, etc.
The Business Partner hereby certifies that the final destination and end-use of the product is:
1. Name of End User (official company name, no abbreviations):
2. Address/ Location where the products will be installed:
a. ☐ Plant name, complete address, and country:
b. ☐ Offshore Platform (name, field name, exact location, and country):
________________________________________________________________________________
c. ☐ Vessel name: (Including ship owner and country of registration):
3. End Use of Products (please check selection):
a. ☐ Civilian industrial application only
b. ☐ Civilian nuclear application/facility
c. ☐ military application
4. Nature of End User’s industry (please check selection):
☐ Oil ☐ Gas ☐ LNG ☐ Food/Beverage ☐ Safety ☐ Mining
☐ Steel ☐ Power ☐ CNG ☐ Petrochemical ☐ Cement ☐ PET
☐ Others:
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5. Reference (Project PO):
End_User_Certificate/2021-8
CERTIFICATE ENDORSMENT
Business Partner End User
Company Name: _________________________ Company Name: _________________________
Complete Address: Complete Address:
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________
State/Province: __________________________ State/Province __________________________
Country: ________________________________ Country: _______________________________
Phone number: __________________________ Phone number: __________________________
Email: __________________________________ Email: __________________________________
Print Name: _____________________________ Print Name: _____________________________
Title / Function: _________________________ Title / Function: _________________________
Place / Date: ____________________________ Place / Date: ____________________________
Signature: _______________________________ Signature: _______________________________
Stamp: Stamp:
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End_User_Certificate/2021-8
