SLAC N AT I ON AL A C C E LE R AT O R C E NT E R
S T ANF O RD S Y N C H R O T R O N R AD I AT I O N L I G HT S O UR CE
INTERNATIONAL USER GROUP
FOREIGN PRINCIPAL PARTY IN INTEREST (FPPI) / U.S. AGENT
I, _______________________________on behalf of ___________________________________,
(Name, Authorized Representative for Int’l User Group)
(Name of Int’l User Group Organization)
the Foreign Principal Party in Interest, that is subject to the jurisdiction of
__________________________________ and having an office and place of business at
(Name of Country)
_________________________________________________________________________
(Address of International User Group)
hereby authorize the Stanford National Accelerator Center (U.S. Agent) at 2575 Sand Hill Road, Menlo Park,
CA 94025 to act as a lawful U.S. agent on the FPPI’s behalf. From this date, the U.S. agent is authorized,
whether in writing, electronically, or by other means to:


Act as the FPPI’s 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 the FPPI and to receive or ship any merchandise on
the FPPI’s 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 Authorized Representative of Int’l User Group)
Signature:
_______________________________
Title:
______________________________
Date:
_______________________________
2575 Sand Hill Road  Menlo Park, CA 94025-7015
SLAC is operated by Stanford University for the U.S. Department of Energy