Letterhead of the end-user/consignee in the country of final destination

End-Use Certificate
for exports to Russia, Belarus
To ensure compliance with Council Res. 833/2014/EU (for dual use items – Annex I to
821/2021/EU, and for items in Annex VII., not applicable for items in Annex II.),
Council Res. 765/2006/EC (for dual use items – Annex I to 821/2021/EU, for items in Annex Va.,
and for items in Annex XIV.)
(including amendments)

A. Parties
1. EXPORTER
Name: Customs number (VPID Number):
Address: Phone/Fax/E-mail:
City, country: Homepage:
Postal Code: Contact person:

2. CONSIGNEE 3. END- USER (if different from the consignee)

Name: Name:
Address: Address:
City, country: City, country:
Postal Code: Postal Code:
Firm register number: Firm register number:
Phone/Fax/E -mail: Phone/Fax/E-mail:
Homepage: Homepage:
Contact person(s): Contact person:

Description of the main activity: Description of the main activity:

4. Country of final destination

B. Items
1. Description of items 2. Quantity Unit price Total value

Grand Total:

End-use
3. Specific purpose for which the items will be used ( please give detailed description)

4. Specification of the end-use location of the items

Certification of foreign consignee or end-user

We (I) certify that the items described in Section B supplied by the exporter named in Section A 1:

1. will only be used for the purposes described in Section B 3 and that the items or any replica
thereof are intended for final use in the country named in Section A 4;

2. that the items or any replica thereof will not be used in any nuclear explosive activity or
unsafeguarded nuclear fuel-cycle activity;

3. that the items will not be used for any purpose connected with chemical or biological or nuclear
weapons, or missiles capable of delivering such weapons;

4. that the items will only be used for civil end-uses (and the items will not be transferred to military
entities);

5. that the items will not be used in connection with human rights violations;

6. that the above mentioned goods will not be used, in their entirety or in part, for projects pertaining
deep water oil exploration and production, Arctic oil exploration and production, or shale oil
projects in Russia.

7. that that the above mentioned goods will not be transferred to any natural or legal person, entity or
body in Crimea and Sevastopol or Donetsk and Luhansk or used in Crimea or Sevastopol or in
Donetsk and Luhansk.

8. that that the above mentioned goods are for

☐ humanitarian purposes, health emergencies, the urgent prevention or mitigation of an event

likely to have a serious and significant impact on human health and safety or the environment or
as a response to natural disasters;
☐ medical or pharmaceutical purpose;
☐ temporary export of items for use by news media;
☐ software updates;
☐ use as consumer communication device;
☐ ensuring cyber-security and information security for natural and legal persons, and bodies in
Belarus / Russia except for its government and undertakings directly or indirectly controlled by
that government;
☐ personal use of the natural persons travelling to Belarus / Russia or members of their immediate
families travelling with them, and limited to personal effects, household effects, vehicles or tools
of trade owned by the individuals and not intended for sale.

☐ cooperation between the Union, the governments of Member States and the government of
Belarus / Russia in purely civilian matters;
☐ the space industry, including cooperation in the academic field and intergovernmental
cooperation in space programmes;
☐ the operation, maintenance, fuel retreatment and safety of civil nuclear capabilities, as well as
civil nuclear cooperation, notably in the field of research and development;
☐ maritime safety;
☐ civilian telecommunications networks, including the provision of internet services;
☐ the exclusive use of entities owned, or solely or jointly controlled by a legal person, entity or
body which is incorporated or constituted under the law of a Member State or of a partner country;
 ☐ the diplomatic representations of the Union, Member States and partner countries, including
delegations, embassies and missions.

☐ urgent prevention or mitigation of an event likely to have a serious and significant impact on
human health and safety or the environment;
☐ contracts concluded before 26 February 2022 (RU) / 3 March 2022 (BY), or ancillary contracts
necessary for the execution of such a contract.

9. as far as technology is concerned, we (I) certify that we (I) treat the technology strictly
confidential and neither pass the technology on to other companies nor shall we (I) make
knowledge available to third parties. In case of goods produced by the help of transferred
technology, these goods will only be delivered to a third person/company on condition that this
third person/company accepts the commitments of the above declaration as binding for itself and
on condition that this third person/company is known to be trustworthy and reliable in the
observance of such commitments.

10. We (I) further certify that we (I) will not re-export the items to third countries.

11. We (I) further declare that the transaction does not fall under embargo on arms and related
materials based on legal acts of the EU, or on the decision of the Organization for Security and
Co-operation in Europe or on the obligatory decision of the United Nations Security Council.

We (I) certify that we are (I am) aware of the content of the restrictive measures imposed in international
sanctions and shall comply with them in specific transactions.

Signature

___________________ _________________________
Place, Date Original signature of consignee or
end-user

__________________________ ________________________________
Company Stamp/ Official Seal_ Name and title of signer in block letters