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
Is the exported item subject to U.S. export control regulations?
If yes, please specify the applicable regulations: |
Will an export license be required for this transaction? If yes, has an export license been obtained? If no export license has been obtained, please specify the basis for license exception/exemption:
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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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