(Letterhead of end-user company or organization) END-USER STATEMENT FOR DUAL USE ITEMS
With reference to our purchase order No ... for (description of goods)
from (name of Norwegian exporter), we hereby declare:
1. The equipment will be used/installed at: (address)
2. The equipment will be used for the following civil application:
(description of type of business or application)
It is hereby certified that the application, to our knowledge, has no relation to weapons of mass destruction or vehicles for delivery of such weapons.
3. The equipment will not be relocated, re-exported or used for other purposes without the prior consent of Norwegian authorities.
4. The installation can be visited at any time, without prior notification, by (name of Norwegian exporter) or its representative.
………..
Name - signature and typed
(Position - general manager or similar of end-user)