Project: _______________________________________________________________________________________________ Name of Supplier: _______________________________________________________________________________________ Address of Supplier: _____________________________________________________________________________________ Country of incorporation of Supplier: ________________________________________________________________________
Description of the item(s): ________________________________________________________________________________ MR/PO number: _________________________________________________________________________________________ Ident/Tag number of the item(s): ___________________________________________________________________________ Export HS or CN Code of the item(s): _________________________________________________________________________
1. EU trade control section A.1) Does your supply (or any component thereof) involve export from European Union (EU) to non-EU Countries or is otherwise subject to EU trade control regulation and/or international economic sanctions? Yes No If yes, please reply to queries from A.2 to A.5 A.2) Is your supply (or any component thereof) a dual-use item pursuant to Regulation (EU) No. 2021/821, as per the latest amendments? Yes No If yes, please indicate Control list No.: ________________________________________________________________ A.3) Is your supply (or any component thereof) listed in any other EU regulation establishing export control restrictions? Yes No If yes, please indicate the applicable export control regime (e.g.: dangerous chemicals, drug precursors, ozone depleting substances, etc.): ________________________________________________________________________________ A.4) Is your supply (or any component thereof) included in any national list of military goods? Yes No If yes, please indicate number and category of military goods: _____________________________________________ A.5) Is your supply (or any component thereof) a listed item as an effect of EU international sanctions against the country of destination specified in the heading? Yes No If yes, please indicate the applicable EU Regulation and Control list No.: ______________________________________

1. U.S.A. Export Control section B.1) Does your supply (or any component thereof) include U.S. products or is the product of U.S. technologies or software? Yes No If yes, please reply to queries from B.2 to B.5 B.2) Is your supply (or any component thereof) subject to the U.S.- Export Administration Regulations (EAR)? Yes No If yes, please indicate the Export Control Classification Number (ECCN): ______________________________________ B.3) Is your supply (or any component thereof) subject to the EAR and controlled pursuant to ECCN 5A002 or 5D002? Yes No If yes, please reply to the following queries: * is Licence Exception ENC [EAR §740.17(b)(3)] applicable? Yes No * is Licence Exception ENC [EAR §740.17(b)(2)] applicable? Yes No * is Licence Exception ENC [EAR §740.17(b)(1)] applicable? Yes No * is Licence Exception ENC [EAR §740.17(a)] applicable? Yes No B.4) Is your supply (or any component thereof) the foreign direct product of U.S.-origin controlled technology or software? Yes No If yes, please indicate the relevant reference: ___________________________________________________________ B.5) Is your supply (or any component thereof) subject to the International Traffic in Arms Regulations (ITAR)? Yes No If yes, please indicate the United States Munitions List (USML) class. No.: _____________________________________
C) Other countries Export Control section (other than EU and U.S., if any) C.1) Does your supply (or any component thereof) involve export from countries other than EU and U.S.A.? Yes No If yes, please reply to query C.2 C.2) Is your supply (or any component thereof) subject to Export Regulations of the countries from where it will be shipped? Yes No If yes, please specify the country or countries: __________________________________________________________ and the regulation: ________________________________________________________________________________
D) Goods from Russia or Belarus D.1) Is your supply (or any component thereof) originating in / being exported from / transiting through Russia or Belarus? Yes No If yes, please specify: ______________________________________________________________________________ D.2) Does your supply (or any component thereof) include 72 or 73 HS code items made of iron / steel originating in Russia? Yes No If yes, please specify: ______________________________________________________________________________
I hereby certify that the information provided herein is accurate and complete. I undertake to promptly inform the Buyer in writing if this information changes. Date / location _____________________________________ Signature ______________________________________ Name and title of the Supplier’s representative _________________________________________________________________

Project: Q-32976 - Tecnmont SKIKDA Folder: RFQ Files