HORIBA UK LIMITED

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REGISTERED OFFICE
KYOTO CLOSE
MOULTON PARK IND. ESTATE TELEPHONE +44(0)1604 542500
NORTHAMPTON NN3 6FL FAX +44(0)1604 542699
REGISTERED NUMBER 2242542 ENGLAND

Trade Compliance Statement

Date:

Customer Company name:

Address:

Name and Title (Capitals):

Signature:

I, the above signed, hereby declare that none of the items ordered by us, nor
any direct product there from, shall be used or acquired for, shipped,
transferred, or re-exported, directly or indirectly, for any of the prohibited end
uses or end users as explained on page 2.

I, the above signed, hereby certify that I have read these terms and conditions.
I also certify that I have performed all enquiries and to my knowledge,

(End-User Company name)

(if different from above)
of (Address)

have not and shall not engage in any transactions that may pose a risk as
defined under the U.S.A, Japanese and UK export regulations. This
acknowledgement of liability pertains to all matters relating to the above-
mentioned end-user

Form HUK 1165 (rev 5) Page 1 of 2

1. End uses
Development, production, use or storage of:
chemical agents for chemical weapons,
bacterial agents for biological weapons, and
nuclear weapons including but not limited to
a) Nuclear explosive activities non-safeguard(including but not limited to
nuclear power applications),
b) safeguarded or non-safeguarded nuclear fuel cycle activities including
chemical processing or irradiated special nuclear or source material,
c) production of heavy water,
d) separation of isotopes of source and special nuclear material,
e) the fabrication of fuel containing plutonium .

Development, production, use or storage of equipment for dispersal of

chemical agents for chemical weapons or bacterial agents for biological
weapons.
Development, production, use or storage of:
a) missile that have a transport range of at least 300 km,
b) unmanned aircraft that have a transport range of at least 300 km

2. End users
1) The following lists issued by BIS (Bureau of Industry and Security) and
OFAC (Office of Foreign Assets Control) of U.S.A.
Denied Persons List (DPI.) Specially Designated Global Terrorists
(SDGT)
Specially Designated Terrorists (SDT) Foreign Terrorists Organization (FTO)
Specially Designated Nationals (SDN) Unverified Lists
Entity Lists(EL)

2) "End User List" issued by METI (Ministry of Economy, Trade and Industry)
of Japan.

3) "Export Control List" issued by UK Department of Innovation, Business &

Skills

Form HUK 1165 (rev 5) Page 2 of 2