Phone: +1-301-330-88111-800-WILCOXON

End Use Certificate

    Request / Order / Contract No.

    Purchasing Company Name, Address, and Country

    Ultimate end-user Name, Address, and Country

    Wilcoxon Part No.

    Description (note 2)

    End Use Application (note 3)

    Notes:  1. Ultimate end-user is the entity that will either directly use the item or will incorporate the item into a new and different product
                 2. Provide basic description (i.e. "Cable Assembly", "Vibration Sensor", etc)
                 3. Indicate end use application (i.e. "Wind Turbine Monitoring", "Industrial Equipment Monitoring", etc)

      I hereby certify that the information procided herein is accurate and complete and that I will inform Wilcoxon Sensing Technologies of any material changes to this certification. I certify that the items identified above:

    1. Will not be resold, exported, re-exported, or disposed in violation of applicable local, United States, or international export control regulations, including the ITAR
        and EAR regulations and OFAC sanction programs.
    2. Will not be used in any nuclear explosive activity or unsafeguarded nuclear end use.
    3. Will not be used for any purpose associated with chemical or biological or nuclear weapons and will not be used for any purpose associated with missiles capable
        of delivering such weapons
    4. Will not be used in Russian oil and gas production applications; reexported to Iran, North Korea, or Syria; or provided for use in a defense/military application in
        Russia, China, or Venezuela
    5. Will not be used in Semiconductor manufacturing application in China, including use in semiconductor manufacturing equipment to be sold to China
    6. Will not be re-exported or resold to any person or entity if there is a reason to believe that it will result directly or indirectly in a use of the items contrary to
        this statement.


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