END USER UNDERTAKING (EUU) Form
(for SIEL/SITCL applications required by Export Control Organisation)
Guidance for UK Licensees
An undertaking is required when applying for a Standard Individual Export Licence (SIEL) or Standard
Individual Trade Control Licence (SITCL) issued by the UK’s Export Control Organisation, part of the
Department for Business, Innovation and Skills. This undertaking forms part of the required supporting
documentation for End-Use Control purposes which is provided when making a licence application to the
ECO.
Please note that we will only normally accept undertakings as valid within 6 months of the date of
the application.
There are two types of undertaking forms available. Which one you – the licensee - obtain in support of
your application depends on how the items will be used.
If goods are being shipped (whether via a consignee or not):
for their end-use or if an end-user is incorporating the goods (ie installing them into another
product or higher level system) – then you should obtain an End-User Undertaking (EUU) Form.
to be held in stock for future delivery or re-sale – then you should obtain a Stockist Undertaking
(SU) Form.
If the overseas company chooses not to use the relevant template, then you should advise them that the
UK Authorities (ie ECO) require an original (not ‘digital’) signed and dated undertaking in English on their
headed paper providing the same information and assurances.
IT IS THE UK LICENSEE’S RESPONSIBILITY TO ENSURE THAT:
The correct undertaking type - i.e. EUU or SU - is supplied with your licence application to cover
the relevant scenario. An incorrect undertaking type will not be accepted by ECO and will
therefore need to be resubmitted, which is likely to result in your application being delayed or
withdrawn.
All sections of the undertaking are completed legibly and in English (or accompanied by an
authorised translation, including header details, if written in a foreign language) by the End User
or Stockist End User on their original official headed paper (where the End User is a company or
a legal entity). The English translation should be verified by the licensee - that is the owner of the
business applying for a licence, or a partner, director or company secretary of the firm, or anyone
authorised to sign the licence application on behalf of the company. Alternatively, if you prefer,
translations may be verified by a member of the Institute of Translators or a Notary Public.
The undertaking form needs to be signed and dated by a person properly authorised by the
End User organisation or Stockist End User organisation to sign on their behalf (the responsible
official). ‘Digital’ signatures are not acceptable.
The same responsible official of the End User organisation or Stockist End User organisation
should also complete, sign, date and attach a covering letter (ie: see Annex A to either EUU or
SU Form). This letter must be on their original official headed paper. It should also be
accompanied by an authorised translation if written in a foreign language (please see above
regarding verification of authorised translations). If the End User or Stockist End user is an
individual then the documents do not have to be on letter headed paper
Copies of the relevant form and covering letter should be attached to the completed licence
application on ECO’s SPIRE database – https://www.spire.bis.gov.uk
The original EUU or SU together with the Covering Letter must be obtained and kept by you at
your premises. These original documents may be requested by ECO at any time.
EUU (Revised July 2012) Page 1 of 6 Designed by Export Control Organisation, BIS
To help reduce further ‘requests for information’ from ECO during licence processing you should
establish as part of your standard procedures whether the items are being shipped to an end user
or a stockist and forward the relevant guidance to them about which form to complete and how to
complete it correctly.
If we request a revised EUU during processing of your application, it should include all of the EUU
pages and be newly dated.
Be mindful of references to any unfamiliar abbreviations or acronyms particularly those referring to
consignees or end-users. To avoid requests for information (RFIs) from ECO which might delay
your application, acronyms should be spelt out in full.
EUU (Revised July 2012) Page 2 of 6 Designed by Export Control Organisation, BIS
Guidance for end-users to complete template and covering letter
This End User Undertaking (EUU) Form and Annex A must be provided when you order goods
which are to be used by you (whether via a Consignee or not). Both documents must be
completed on your company’s letter headed paper. Please note that if you are an individual these
documents do not have to be on letter headed paper.
Please read the following ‘Explanation of Terminology’ carefully for guidance on completing the
EUU form.
1
The UK Licensee is the person or body who is either exporting the goods abroad, or brokering
the movement of the goods concerned, each of which may be direct to you or via a separate
consignee.
2
If not known, the Licensee’s Reference can be left blank for completion by the Licensee.
3
The Consignee is the person or body, who is the first recipient of the goods .This can be
yourselves or it can be another person or body within your country or in another country. If you
are both the Consignee and the End User, then you must enter your own details in boxes (c) and
(d).
4
As the End User you will be receiving the goods for end-use so boxes (e) and (f) must be
completed. If you incorporate the goods into another product or higher level system, then you
are still the End User for the purposes of the movement of the items.
5
The End User in this section refers to the entity at the time of shipment.
6
The goods in this section refer to those at the time of shipment. NB: If goods are being
incorporated into another product or higher level system then this information should be included
in Section 3.
7
The UK Authorities need to understand what the goods are and so a detailed description of the
main item or items is required. If, for example, the main item or items are accompanied by a long
list of spares, components or accessories, you should also indicate this in section 2.
8
If the goods are to be ‘incorporated’ by you (ie: installed into another product or higher level
system) then that product/higher level system, its use and ultimate end user (which may be within
or outside your destination) should be described where known in Section 3.
9
Section 4 must be signed and dated by you as the End User since you are using the goods
mentioned in Section 2. This includes where you incorporate the goods into another product or
higher level system. This section should be signed and dated by a person within your
organisation with authority to sign on behalf of the company/organisation. ‘Digital’ signatures are
not acceptable
10
For an up-to-date list of applicable destinations subject to arms embargoes, please go to the
export control pages of the Businesslink website and access the link to “Current Export
Restrictions”
EUU (Revised July 2012) Page 3 of 6 Designed by Export Control Organisation, BIS
EUU FORM
SECTION 1 – PARTIES
(a) Name of UK Licensee 1 (b) Licensee’s Reference 2
SERCON AUSTRALIA Pty Ltd
(c) Name of Consignee 3 (d) Consignee’s Address
DIMAS ERLANGGA LUFTIMAS, MD Health Technology Study Center
Faculty Of Medicine Universitas Padjadjaran
Jl.Eijkman No.38, Bandung
West Java Indonesia
40161
(e) Name of End-User 4 (f) End-User’s Address
DIMAS ERLANGGA LUFTIMAS, MD Health Technology Study Center
Faculty Of Medicine Universitas Padjadjaran
Jl.Eijkman No.38, Bandung
West Java Indonesia
40161
(g) Is the End user the armed forces or (h) Specific location where goods will be
internal security forces of the used or based (if known) and if different
country ? 5 from (f) 6
No Sumedang District, West Java, Indonesia.
Bandung City, West Java, Indonesia.
SECTION 2 – GOODS
(a) Quantity of (b) Description of the Goods 7
Goods (for consumable goods, include length of time supplies are expected to
last)
12 Kgs
Deuterium Oxide 99.8 atom%, Code# SD617385 from SERCON,
Cheshire, UK.
A Deuterium Oxide, water stable isotope that has been used for long
time (first in 1982) as an indicator for water composition measurement.
The isotope labelled water is an indicator of exclusive breastfeeding
measured from mother saliva and also breastfed baby saliva.
The goods are expected to last until 2019.
(If you need to use continuation sheets, each must carry the licensee’s reference, and
must be signed and dated by the same person who signs this form.)
EUU (Revised July 2012) Page 4 of 6 Designed by Export Control Organisation, BIS
SECTION 3 – END-USE OF THE GOODS
Please set out the specific purposes for which the goods are to be used by the end-
user (including, if applicable, where the goods are being incorporated) 8
The goods (Deuterium Oxide, D2O) will be used as an indicator of breastfeeding practice.
The D2O will be taken to the Pharmacokinetic Laboratory, Faculty of Medicine Universitas
Padjadjaran and will be aliquot into 30g/bottle for 400 bottles. The bottles will be brought to
Sumedang district, and Bandung City, where respondents will drink the water. The D2O
concentration of mother saliva will be measured, as well as the baby whose are breastfed by
the mother
SECTION 4 – END-USER UNDERTAKING 9 (to be completed by the person or body named in 1(e)
and 1(f))
We – the person or body named at 1(e) and 1(f) – certify that we are the end-user of the goods
described in Section 2, which are to be supplied by the licensee named in 1(a). We further certify that we
shall use the goods for the purposes described in Section 3; that the goods will not be used for any
purpose connected with chemical, biological or nuclear weapons, or missiles capable of delivering such
weapons; that they will not be re-exported or otherwise re-sold or transferred if it is known or suspected
that they are intended or likely to be used for such purposes; that the goods will not be re-exported or
otherwise re-sold or transferred to a destination subject to UN, EU or OSCE embargo where that act
would be in breach of the terms of that embargo 10; and that the goods, or any replica of them, will not be
used in any nuclear explosive activity i or unsafeguarded nuclear fuel cycle ii.
Sign Here _____________________________ Date April 11, 2018
(Signature of official of End User)
Print Name DIMAS ERLANGGA LUFTIMAS, MD
(Add Name of Signatory in Capitals)
Role STUDY COORDINATOR, HEALTH TECHNOLOGY STUDY CENTER
FACULTY OF MEDICINE UNIVERSITAS PADJADJARAN
(Add Job Title of Signatory in Capitals)
Note
i includes research on or development, design, manufacture, construction, testing or maintenance of any nuclear
explosive device or components of subsystems of such a device.
ii includes research on or development, design, manufacture, construction, operation or maintenance of any reactor,
critical facility, conversion plant, fabrication plant, reprocessing plant, plant for the separation of isotopes of source or
special fissionable material, or separate storage installation, where there is no obligation to accept IAEA safeguards at
the relevant facility or installation, existing or future, when it contains any source or special fissionable material; or of
any heavy water production plant where there is no obligation to accept IAEA safeguards on any nuclear material
produced by or used in connection with any heavy water produced therefrom; or where any such obligation is not met.
EUU (Revised July 2012) Page 5 of 6 Designed by Export Control Organisation, BIS
KEMENTERIAN RISET, TEKNOLOGI DAN PENDIDIKAN TINGGI
UNIVERSITAS PADJADJARAN
FAKULTAS KEDOKTERAN
Jl. Raya Bandung-Sumedang Km21, JatinangorSumedangTelp. (022) 7796373, 7795594 Fax. 7795595
Jl.Prof.Eikjman No.38 Bandung Telp. (022) 2032170, 2038114 & 2038115 Fax 2037823
Laman www.fk.unpad.ac.id
April 11, 2018
End User Undertaking relating to the UK licence application made by SERCON AUSTRALIA Pty Ltd
I attach a completed End User Undertaking made on the EUU Form
Yours sincerely
Dimas Erlangga Luftimas, MD
Health Technology Study Center
Faculty of Medicine, Universitas Padjadjaran
EUU (Revised July 2012) Page 6 of 6 Designed by Export Control Organisation, BIS
