Bosch End User and Consignee Statements

General:
The following forms must be completed and signed by a company officer in order to purchase any Bosch Thermal Imaging surveillance camera.

Information provided in the “End-User Statement” will be reviewed by Bosch Export specialist and used to determine if an export license application must be submitted.

Depending on the frame rate specification, installation location, and intended application, an export license may be required.

The “End-User Statement” must be completed by all customers.

If purchasing a camera model having frame rate of 25/30/50/60Hz that will be installed in any of the countries listed below, the “Consignee Statement” on last page must also be completed and returned to Bosch. (The “Consignee Statement” is not required for camera models having ≤9Hz frame rates.)

“Consignee Statement” countries:

Argentina, Australia, Austria, Belgium, Bulgaria, Canada, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Ireland, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, Turkey, the United Kingdom, and the United States.

How to use these forms:

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Once the form(s) are completed, print on paper with your company’s letterhead, sign the form(s), and then send to the Bosch Security Systems Order Desk via mail, fax, or other electronic means.

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Bosch End-User Statement

We, enter end-user company name, understand that the Bosch Thermal Imaging surveillance camera contains components that are controlled for export by the United States Department of Commerce, Bureau of Industry and Security. Sale or transfer of this camera system may require prior approval of the US Government.

We certify that the Bosch Thermal Imaging surveillance camera and/or its components will be used for enter intended purpose of the camera in enter City and Country where cameras will be installed.

We further certify that the Cameras will not be used or sold for use for any of the following activities:

A. Nuclear explosive activities, safeguarded and/or unsafeguarded nuclear activities including research,
development, design, manufacture, construction, testing or maintenance of any nuclear explosive device or components or subsystems.

B. Rocket Systems (including ballistic missile systems and space launch vehicles, sounding rockets, unmanned
air vehicles including cruise missile systems, target drones and reconnaissance drones).

C. The design, development, production, stockpiling or use of chemical or biological weapons.

The following Bosch Thermal Imaging surveillance camera(s) will be used:

Commercial Type Number	Quantity	Customer Purchase Order number

We understand and acknowledge that we are responsible for compliance to export regulations, including any returns for repair and/or other services.

Authorized Signature:

Print Name:

Position/Title:

Company Name:

Address:

Date:

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Bosch Consignee Statement

As required by the U.S. Export Administration Regulations (EAR), License Exception STA – Strategic Trade Authorization, this document shall serve as our “Consignee Statement.” This Consignee Statement only applies to those Bosch Camera Assemblies that meet the specifications as defined in ECCN 6A003b.4.b and therefore eligible for this License Exception, all other destinations will require a US export licenses from the U.S. Bureau of Industry and Security.

We, enter end-user company name, acknowledge, understand and declare the following:

Is aware that Bosch Camera Assembly containing an ECCN: 6A003b.4.b thermal imaging block will be shipped pursuant to License Exception Strategic Trade Authorization (STA) in § 740.20 of the United States Export Administration Regulations (15 CFR 740.20);

Is hereby informed of the applicable ECCN number noted above;

Understands that items shipped pursuant to License Exception STA may not subsequently be re-exported pursuant to paragraphs (a) or (b) of License Exception APR (15 CFR 740.16 (a) or (b));*

Agrees to obtain prior consignee statement when using License Exception STA for any reexport or transfer (in-country) of the items previously received under License Exception STA;

Agrees not to export, re-export or transfer these items to any destination, use or user prohibited by the United States Export Administration Regulations;

Agrees to provide copies of this document and all other export, reexport or transfer records (i.e. the documents described in 15 CFR part 762) relevant to the items referenced in this statement to the U.S. Government as set forth in 15 CFR 762.7;

We understand that prior to any re-export or re-transfer of this equipment under the STA exception requires we must obtain this same “Consignee Statement” from the new consignee;

Agrees to permit a U.S. Government end-use check with respect to the items.

Note: The authorized export, re-export and transfer countries are:

Argentina, Australia, Austria, Belgium, Bulgaria, Canada, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, India, Ireland, Italy, Japan, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, South Korea, Spain, Sweden, Switzerland, Turkey, the United Kingdom, and the United States.

Link to the U.S. Export Administration Regulations: https://www.bis.doc.gov/index.php/regulations/export-administration-regulations-ear

By signing below, you additionally agree and certify that the Bosch Camera Assembly as described in this Statement will not be exported, reexported, or transferred to a restricted party or a sanction/embargoed destination.

Acknowledged and Certified by:

______________________________	_______________________________

Signature	Date

______________________________	_______________________________

Printed Name	Title

* Unless otherwise authorized; see Sections 734.4 “De minimis” and 750.7i “Terminating License Conditions”