[Letterhead of the end-user in the country of end use]
End-Use Certificate for Defence-Related Products and Law Enforcement Materials
For presentation to the Export Control Authorities of Belgium (Flemish Region)1
Reference number N°
A. Parties
1. Exporter / Consigner
4. Country of End Use
2. Consignee
3. End-User
B. Goods and end-use
1. Goods
2. Quantity
3. Value
4. End-Use
5. Specification of the end-use location of the goods
6. Contract or invoice details
1
Strategic Goods Control Unit, Flemish Department of Foreign Affairs, Boudewijnlaan 30, 1000 Brussels, Belgium.
Legalisation required by Belgian embassy or local Chamber of Commerce Stamp
C. Commitments of the end-user
I (We) certify that the goods 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 4 and that these goods are intended for final
use in the country named in Section A 4;
2. will not be used for any purpose connected with goods, the use, development, production, stockpiling,
retention, acquisition, supply or transfer of which is prohibited on the basis of: a) the Convention of 13
January 1993 on the prohibition of the development, production, stockpiling and use of chemical
weapons and on their destruction; b) the Convention of 10 April 1972 on the prohibition of the
development, production, stockpiling of bacteriological (biological) and toxin weapons and on their
destruction; c) the Convention of 18 May 1977 on the Prohibition of Military or Any Other Hostile Use
of Environmental Modification Techniques; d) the Convention of 18 September 1997 on the Prohibition
of the Use, Stockpiling, Production and Transfer of Anti-personnel Mines and their Destruction; e) the
Convention of 30 May 2008 on Cluster Munitions; or f) the Convention of 10 October 1980 on
Prohibitions or Restrictions on the Use of Certain Conventional Weapons Which May be Deemed to
be Excessively Injurious or to Have Indiscriminate Effects and its protocols;
3. will not be used for any purpose connected with inert munitions or armoured protection containing
depleted uranium or any other industrial uranium;
4. will not be used for any purpose connected with chemical or biological or nuclear weapons, or missiles
capable of delivering such weapons nor in any nuclear explosive activity or unsafeguarded nuclear
fuel-cycle activity;
5. will not be used for violations of: a) human rights; b) international humanitarian law; c) the prohibition
of the use of force as referred to in Article 2 of the Charter of the United Nations; and d) the United
Nations conventions relating to terrorism and transnational organized crime;
6. will not be used, delivered, transferred or exported in violation of any restrictive measures issued by
the United Nations, the European Union or the Organisation for Security and Cooperation in Europe;
7. will not be used, delivered, transferred or exported in violation of restrictions on the end use of the
goods or on the export of the goods of which we the end user is notified by the exporter named in
Section A 1;
8. will not be delivered to another entity, nor transferred or exported to another country for the purpose of
any of the activities listed in point 2 to 7;
9. will, during the validity term of the transfer or export license, not be exported as such to another
country than named in Section A 4 without subsequent notification to the Government of Flanders;
10. will only be delivered to another entity on condition that this entity accepts in writing the commitments
of the above declaration as binding for itself and on condition that this entity is known to be trustworthy
and reliable in the observance of such commitments.
I (We) hereby certify that:
- I (We) have the authority to legally bind the end user named in Section A 3 and have the
legal capacity to make commitments on behalf of the end user;
- all the information contained in this document is true and correct;
- the end user will comply with the above-mentioned commitments.
Signature:
___________________________________
Place, Date
___________________________________
Official signature of end-user
___________________________________
Company Stamp / Official Seal
___________________________________
Name and title of signer(s) in block letters
Legalisation required by Belgian embassy or local Chamber of Commerce Stamp