Free Administration Export Compliance Form Template

Administration Export Compliance Form

Date: [Month, Day, Year]


Exporter Information

Exporter Name:

[Your Company Name]

Exporter Address:

[Your Company Address]

Exporter Contact Number:

[Your Company Number]

Exporter Email:

[Your Company Email]

Exported Item Information

Exported Item Information:

[High-performance microprocessors]

Export Control Classification Number (ECCN) or Commodity Classification Automated Tracking System (CCATS):

Quantity:

Unit Value:

Total Export Value:

End-User Information

End-User Name:

[Your Partner Company Name / Second Party]

End-User Address:

End-User Contact Number:

End-User Email:

End-Use:

Destination Information

Destination Country:

[Canada]

Final Destination Address (if different from End-User Address):

Intended Date of Export:

Export Control Information

  1. Is the exported item subject to U.S. export control regulations?

  • Yes

  • No

If yes, please specify the applicable regulations:  

                                                                                                                                   

  1. Will an export license be required for this transaction?

    • Yes

    • No

    If yes, has an export license been obtained?

    • Yes

    • No

    If no export license has been obtained, please specify the basis for license exception/exemption:

                                                                                                                            

Certification:

I, [Your Name], certify that the information provided in this Administration Export Compliance Form is accurate and complete to the best of my knowledge. I understand that any false or misleading statements may result in penalties under U.S. export control laws and regulations.

[Month, Day, Year]


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