联合国禁止化学武器公约列管化学物质最终用途保证书申....pdf

聯合國禁止化學武器公約列管化學物質最終用途保證書申請書 APPLICATION FOR END-USE CERTIFICATE FOR CHEMICALS OF CHEMICAL WEAPONS CONVENTION 證號 Certificate No. 發證日期 Issue Date 進口人（名稱及地址）Importer (Name and Address) 出口人（名稱及地址）Exporter (Name and Address) 最終使用人（名稱及地址）End-user (Name and Address) 商品分類號列 貨品明細（名稱、型號、規格） 數量／單位 金額（貨價條件） C.C.C. Code (CAS No.) Description of Goods Quantity Value(FOB, CIF, etc) 貨品之最終用途 End-use of Goods 進口人及最終使用人切結： 1.貨品將用於上述記載之最終用途，絕不用於聯合國禁止化學武器公約所禁止之用途且不移轉作其他用途。 2. 貨品將依上述內容輸入中華民國境內，絕不轉運至其他國家且不移轉其他使用人。 3. 上述內容均已據實填報並願遵守”高科技貨品輸出入管理辦法”之規定，如有不實或不法情事願依貿易法第二十七條二十 七條之一或二十七條之二之規定接受刑事及(或)行政之處罰。 The importer and the end-user undertake: 1. To use the goods for the purposes above mentioned, not prohibited under Chemical Weapons Convention and not retransferred to other end use(s). 2. To import the aforesaid goods into the Republic of China and not retransfer it to any other country or end-user(s). 3.To fill out this document in good faith and to comply with the “Regulations Governing Export and Import of Strategic Hi-Tech Commodities”. Any false statement will fully made in this document or any violation occurred is subject to criminal punishment and/or administrative sanction in accordance with the article 27, 27-1 or 27-2 of the “Foreign Trade Act”. 最終使用人印鑑 Stamp of 茲證明進口人及最終使用人已向本發證機構具結上述內容，本保證書副 end-user 本並已存檔列管。 It is hereby certified that the above declaration was made to this certifying authority and a copy of this certification is placed in the official files. 進口人印鑑Stamp of Importer 發證機構:科學工業園區管理局 發證機構印信Official Stamp Certifying Authority: SCIENCE-BASED INDUSTRIAL PARK