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END USER STATEMENT

A completed end-use statement is required for the completion of your order. Please complete the following end-use template on your Company
Letterhead.
Date: Purchase Order or
Quote Number:
Ultimate End-User:
(Company Name)
Ultimate Destination:
(Company’s Address)

In reference to the information above, Ultimate End-User located at Ultimate Destination acknowledges that National Instruments Products and
Technology will be exported or transferred, as applicable, in accordance with applicable Export Control Regulations, including but not limited to the
U.S. Export Administration Regulations and other applicable local national “Catch-All” regulations, and that diversion contrary to law is prohibited.
Ultimate End-User certifies the following:

1. Products and technology obtained will be employed in

Define application: of
In the field of /
Define end-product: to be used in

Define Industry: (See Footnote1)

2. Products and technology obtained will NOT be used, directly or indirectly, in the (1) design, development, fabrication, handling, operation,
maintenance, storage, detection, identification, dissemination or testing of nuclear weapons or explosive devices; or (2) design, construction,
fabrication, or operation of facilities or components of facilities for chemical processing of irradiated special nuclear or source material, heavy
water production, separation of isotopes of source and special nuclear material, or fabrication of nuclear reactor fuel containing plutonium.

3. Products and technology obtained will NOT be used directly or indirectly to assist in the design, development, fabrication, operation,
maintenance, or storage of (1) rocket systems (including ballistic missile systems, space launch vehicles, and sounding rockets); or (2) unmanned
air vehicle systems (including cruise missile systems, target drones, remotely piloted vehicles, and reconnaissance drones).

4. Products and technology obtained will NOT be used in the design, development, production, handling, operation, maintenance, stockpiling,
detection, identification, dissemination or use of chemical or biological weapons.

5. Products and technology obtained will NOT be diverted to (1) Cuba, Iran, North Korea, Sudan, Syria or other country sanctioned by a United
Nations Security Council decision, (2) a military end-use in China, (3) any use or purpose prohibited by any applicable export control restriction or
trade sanction, or (4) to an entity or person on any applicable export control government restricted party “watch” lists.

6. Products and technology obtained will remain at Ultimate Destination and will NOT be resold or transferred without the appropriate
authorization from the applicable Export Control Government(s). The Ultimate Destination is not a customs free zone or free warehouse.2

7. Ultimate End-User will be the ultimate end user of the products and technology obtained.
I certify that I am authorized to represent the Ultimate End-User If you are purchasing through an Intermediate party (e.g. Freight
and understand the certifications stated above. Forwarder, Distributor, etc.), please also provide Purchasing
Company Information below:

Name: Purchasing Company:


Ship To Address:
Signature:
Title:
Department: Contact Person:
Website: Website:

1Based on the end-use information provided above, additional information/clarification may be required.
Examples of an acceptable End Use Statement:
NI products and technology obtained will be employed in the development of test fixtures to be used in the testing of silicon chips.
NI products and technology obtained will be employed in the automation of seat belt resistance testing in the field of commercial aircraft.
NI products and technology obtained will be employed in the data acquisition of isotope decay rates in the field of molecular research.
2 Customs free zones or free warehouses are defined locations within the territory of the country of Ultimate Destination separated from the rest of its territory and supervised by the

competent customs authorities for the purposes of storing certain goods that have not yet been released into free circulation in that country. The goods stored in such places are treated as
if they were located outside the customs territory of the given country. Other premises and places in which goods are subject to similar customs rules and treatment to those described
above shall be relevant with regard to statement No. 6 of this End User Statement.
NI Ultimate End-User Statement (EUS) v7 07132012 Page | 1

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