STANFORD SYNCHROTRON RADIATION LIGHTSOURCE
LINAC COHERENT LIGHT SOURCE
POWER OF ATTORNEY
INDIVIDUAL INTERNATIONAL USER
FOREIGN PRINCIPAL PARTY IN INTEREST (FPPI) / U.S. AGENT
I, ___________________________________, the Foreign Principal Party in Interest
(Name of Individual International User)
who is subject to the jurisdiction of ____________________________ and having an office and
(Name of Country)
place of business at _________________________________________________________
(Address of Individual International User)
hereby authorize the SLAC National Accelerator Laboratory (U.S. Agent) at 2575 Sand Hill Road, Menlo Park, CA
94025 to act as a lawful U.S. agent on my behalf. From this date, the U.S. agent is authorized, whether in writing,
electronically, or by other means to:


Act as my U.S. agent for Export Control, Census Reporting and Customs purposes;
Make, endorse or sign any Shipper’s Export Declaration or other documents or to perform any act which
may be required by law or regulation in connection with the exportation or transportation of any
merchandise shipped or consigned by or to me and to receive or ship any merchandise on my behalf.
I hereby certify that all statements and information contained in the documentation provided to the U.S. Agent
relating to exportation are true and correct. Furthermore, I understand that civil and criminal penalties may be
imposed for making false or fraudulent statements or for the violation of any United States laws or regulations on
exportation.
This power of attorney is to remain in full force and effect until revocation in writing is duly given by me and
received by the U.S. Agent.
Signed,
____________________________________________
(Full Printed Name of Individual International User)
Signature:
Title:
Date:
_______________________________
______________________________
_______________________________
SLAC NATIONAL ACCELERATOR LABORATORY • 2575 SAND HILL ROAD • MENLO PARK • CALIFORNIA • 94025 • USA
SLAC is operated by Stanford University for the U.S. Department of Energy