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Export Compliance Checklist MANDATORY COMPLIANCE FORM FOR ALL ORDERS: I have checked Order #__________________ Dated_________ Customer _____________________________ Name of Company / Consignee : ____________________________ In the following Country: _____________________________ . License Jurisdiction DOC___________ ECCN ______________ Type of license ________________ _________ Verification of all Denied Parties lists check (not on list) [_] The Denied Persons List (Bureau of Industry & Security) web address http://www.bis.doc.gov/dpl/Default.shtm [_] Specially Designated Nationals (Office of Foreign Assets Control) web address http://www.ustreas.gov/offices/enforcement/ofac/sdn/t11sdn.pdf http://www.ustreas.gov/offices/enforcement/ofac/sdn/t11sdnew.pdf (changes to list) [_] Unverified List (Bureau of Industry & Security) web address http://www.bxa.doc.gov/Enforcement/UnverifiedList/Unverified_Partie s.html [_] Country Sanctions List (Office of Foreign Assets Control) web address http://www.treas.gov/offices/enforcement/ofac/sanctions/index.html (click on country) [_] List of Non-proliferation Embargoes (Gatti & Associates) web address http://www.gattiassociates.com/ ________ Customer Has Export Power of Attorney on File ______________________ Signature ______________ Date Please note that Cargo Rates International LLC takes no legal or financial responsibility for the use, content, or accuracy of information provided. This is not an official document of the U.S. Department of Commerce or any other agency of the U.S. Government. It is a tool to assist in determining Export compliance.