Annex A - Official Documents
Annex A - Official Documents
Annex A - Official Documents
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2005 Strategic Export Controls<br />
104<br />
L 200/16 EN <strong>Official</strong> Journal of the European Union 30.7.2005<br />
EUROPEAN COMMUNITY<br />
1 Applicant (full name, address, customs number) Type; AUTHORISATION FOR<br />
EXPORT OR IMPORT OF GOODS THAT COULD BE<br />
USED FOR TORTURE<br />
(REGULATION (EC) No 1236/2005<br />
2 Consignee (full name and address)<br />
5 Agent/Representative (if different from applicant)<br />
9 End-user (full name and address)<br />
10 Description of item<br />
14 Specific requirements and conditions<br />
10 Description of item<br />
14 Specific requirements and conditions<br />
10 Description of item<br />
14 Specific requirements and conditions<br />
3 Authorisation No<br />
Export Import<br />
4 Expiry date<br />
6 Country where the goods are located Code<br />
7 Country of destination Code<br />
8 Member State where a Customs procedure will take<br />
place<br />
Issuing<br />
authority<br />
15 The undersigned certifies that, pursuant to Article 9(1) of Regulation 1236/2005 and subject to the requirements,<br />
conditions and procedures setout in this form and the attachment(s) to which it refers, the competent authority has<br />
authorised [an export] [an import] (delete as appropriate) concerning the goods described in box 10.<br />
16 Number of attachments<br />
Done at (place, date)<br />
Name (typed or capitals)<br />
Signature: (Stamp of Issuing authority)<br />
11 item<br />
No 1<br />
11 item<br />
No 2<br />
11 item<br />
No 3<br />
12 CN code<br />
13 Quantity<br />
12 CN code<br />
13 Quantity<br />
12 CN code<br />
13 Quantity
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