[별지 제2호의3 서식]

Annexed paper No. 2-3

END-USER STATEMENT (For Wassenaar Arrangement Items Only)
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 & chemical weapons and missiles or "Conventional Weapons". 2. will not reexport it or its derivatives to another country without prior consent of the end-user’s export licensing authorities.
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.