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Miralon Export Compliance Form

Miralon Materials for Export: End-User / End-Use Statement

INSTRUCTIONS:  This form must be completed by the END-USER.  To ensure compliance with applicable export control, sanctions, and import requirements, Huntsman requires details regarding the parties to the transaction and end-uses for its products, services, and technologies (the “Deliverables”).  If you have any questions, your Huntsman point of contact will assist you in completing the form.  Please return the completed and signed form to your Huntsman point of contact.  If any information in this statement, including the proposed end-use/application, changes after you have completed and returned the form to Huntsman, you are required to immediately notify Huntsman (including your point of contact) in writing describing such change(s).

Section A : END-USER (“CUSTOMER”) INFORMATION

Please enter the name of the individual person that is primarially responsible for using or evaluating the material.
Please enter the name of the team, company or organization that the end-user is affiliated with.
Please enter the primary physical address that the material will be used at.
Please enter the country that the Team, Company, Organization or Entity is legally based or orgainzed in.
Please enter the website or websites that are affiliated with this end user.
Please enter a good phone number for the primary end-user that we may use to contact if necessary.
If applicable, please enter additional individuals and their contact phone numbers.
For example, is the entity any of these or similar to these organizations: national armed services (army, navy, marine, air force, or coast guard), national guard, national police, or government intelligence or reconnaissance organization?
Is the Entity a Commercial Entity that develops, produces, maintains, or uses military items; or engages in activities in support of an intelligence or reconnaissance organization of the armed services or national guard?
Please provide names for the Direct and Indirect Owners (and their percent ownership), Up Through Ultimate Beneficial Owners

Section B : DISTRIBUTOR INFORMATION (If Applicable)

If the end user intends on purchasing Miralon materials through a local/regional distribtor or supplier entity in your local country, please complete this secton. (This section is not necessary if the end user purchases directly from Huntsman or directly from Perigee Direct)
Please enter the name of the team, company or organization that the end-user is affiliated with. (This section is not necessary if the end user purchases directly from Huntsman or directly from Perigee Direct)
(This section is not necessary if the end user purchases directly from Huntsman or directly from Perigee Direct)
Please enter the country that the Distributor is legally based or orgainzed in.
Please enter the website or websites that are affiliated with this end user.
Please enter a good phone number for the Distributor that we may use to contact if necessary.
Please provide names for the Direct and Indirect Owners of the Distributor (and their percent ownership), Up Through Ultimate Beneficial Owners

Section C : End Product / Process Use Statement

Please describe the end or finished product that the miralon materials will be used to produce.
What is the name or description of the product or process that Miralon Materials will get used in?
If this end product or process is related to another project or product, please describe the Contract Number, Purchase Order Number, or other purchase/demand related Identifyer for this end product.
What is the ECC of this finished product? if applicable
Please describe the annual quantity that will be produced and the unit of measure as best as u can with what you know now.
How much is the end product worth, or what is the price paid for it. Please describe the currency also.
Describe End-Use for the product that Miralon and any other Huntsman products will be used to make.
Describe Production Process Using Miralon and any other Huntsman proucts.
Describe Your End-Product and its Applications, including General Technical Characteristics (e.g., glass transition temperature, specific modulus size, specific tensile strength, etc.):
Specific Division or Branch, and Exact Location, of the Entity that will be Using the Huntsman Deliverables:

Section D : End Use Declarations

Section D.1 : For End-Use Related to Nuclear

Please indicate whether the Huntsman Deliverables / Your End-Product will be directly or indirectly used for any of the following:
Any uses including research on, or development, design, manufacture, construction, testing, or maintenance of, any nuclear explosive device, component, or subsystem
Any uses including research on, or development, design, manufacture, construction, operation, or maintenance of, any nuclear reactor, critical facility, facility for the fabrication of nuclear fuel, facility for the conversion of nuclear material from one chemical form to another, or separate storage installation
Any use including research on, or development, design, manufacture, construction, operation, or maintenance of, any of the following facilities, or components for such facilities: (i) facilities for the chemical processing of irradiated special nuclear or source material; (ii) facilities for the production of heavy water; (iii) facilities for the separation of isotopes of source and special nuclear material; or (iv) facilities for the fabrication of nuclear reactor fuel containing plutonium
Any project that includes plants, land prototypes, and special facilities for construction, support, or maintenance of maritime propulsion.

Section D.2 : For End-Use Related to Missle Technology

Please indicate whether the Huntsman Deliverables / Your End-Product will be directly or indirectly used for any of the following:
Design, development, production, operation, installation, maintenance, repair, overhaul, or refurbishing of rocket systems (including ballistic missiles, space launch vehicles, and sounding rockets) or unmanned aerial vehicles (including cruise missiles, target drones, and reconnaissance drones)

Section D.3 : For End-Use Related to Chemical or Biological Weapons Production

Please indicate whether the Huntsman Deliverables / Your End-Product will be directly or indirectly used for any of the following:
Design, development, production, stockpiling, operation, installation, maintenance, repair, overhaul, or refurbishing of chemical or biological weapons or a whole plant to make chemical weapons precursors

Section D.4 : Military/Defense or Military/Defense Intelligence

Please indicate whether the Huntsman Deliverables / Your End-Product will be directly or indirectly used for any of the following:
A military end-use or application (including incorporation of the Huntsman Deliverables or Your End-Product into a military/defense item or a product otherwise used by a military end-user) or otherwise supporting or contributing to the operation, installation, maintenance, repair, overhaul, refurbishing, development, or production of military/defense items or other items for military/defense uses or applications
A military-intelligence end-use or application, including development, production, operation, installation, maintenance, repair, overhaul, or refurbishing of, or incorporation into, a military/defense/intelligence item to support a military-intelligence end user (i.e., an intelligence or reconnaissance organization of the armed services or national guard)

Section D.5 : Additional End Uses or Applications

Please indicate whether the Huntsman Deliverables / Your End-Product will be directly or indirectly used for any of the following:
One of the following energy-related projects: (i) support of exploration or production for deepwater (depths of more than 500 feet), Arctic offshore, or shale projects that have the potential to produce oil or gas; or (ii) maintenance or expansion of the construction, modernization, or repair of energy export pipelines, including activities or support for vessels engaged in pipe-laying or other pipe-laying activities for construction of the Nord Stream 2 pipeline project, the TurkStream pipeline project, or any successor project

Section E : CERTIFICATION

We acknowledge that Huntsman’s products, services, and/or technology specified in the above-referenced contract or purchase order (the “Deliverables”) are subject to U.S., EU, and United Nations export and import laws, regulations, and requirements and agree to comply with all such applicable laws, regulations, and requirements.

We understand that the direct or indirect export, reexport, or transfer (in-country) of the Deliverables, or any product incorporating or developed with the Deliverables, to or in a third country or to, by, or for a different end-user or end-use may require government approval.  We agree to obtain any necessary export license or other government authorization to export, reexport, or transfer (in-country) the Deliverables or any product incorporating or developed with the Deliverables.  We also specifically agree not to, directly or indirectly, export, reexport, transfer (in-country), or otherwise allow access to or use of the Deliverables or any product incorporating or developed with the Deliverables to, by, or for an end-user or end-use prohibited by applicable laws, regulations, or requirements.

I certify that all information herein is true, correct, and complete to the best of my knowledge and that Company/Entity will immediately notify Huntsman in writing if any information provided in this statement changes.

Please enter your name, the name of the person completing this form.
Please enter your Title
Please enter your company name
Please enter the date and time, as best you can.