[별지 제2호의2 서식]

Annexed paper No. 2-2

END-USER STATEMENT
① END-USER
NAME OF FIRM
ADDRESS
CITY				COUNTRY
② REPRESENTATIVE OF THE FIRM
NAME					TITLE
③ CONTACT PERSON
NAME					TITLE
TELEPHONE					E-MAIL
④ TYPE OR NATURE OF BUSINESS
⑤ PURCHASE CONTRACT
ITEM (Including Software & Technology)
QUANTITY
PURPOSE OF USE
PLACE OF STORAGE (Specifically with address)
⑥ STATEMENT OF END-USER
We, as end user of the above item(s), certify that we: 1. will use it only for the purpose described above, and will not use it or its derivatives for the development or manufacturing of "Weapons of Mass Destruction" such as nuclear, biological and chemical weapons, missiles or conventional weapons. 2. will not resell or reexport it or its derivatives to another country or another person without prior consent of the Korean Licensing Authorities. If it should be resold or reexported with appropriate reasons, we will get the prior approval from the exporter. (For the Nuclear Trigger items specified in the NSG Guideline Part 1, this prior approval is not necessary on the condition that written permission of the exporter's government is provided.)
⑦ SIGNATURE OF AUTHORIZED PERSON (OR OFFICIAL SEAL)
NAME OF PERSON SIGNING THIS DOCUMENT			TITLE OF PERSON SIGNING THIS DOCUMENT						DATE(mm dd, yyyy)

* Note to the exporter: In case of the Item-based Comprehensive export license, please leave “quantity” blank.