PART A. 1 Registered person's name. 2 Registration number. 3 Address. Postal code. 4 Consignee's name. 5 Address. Postal Code. 7 Consignor's name

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1 The Secretariat South African Council for Non-proliferation Private Bag X84 PRETORIA, 0001 Tel Fax IMPORT PERMIT APPLICATION PART A Use this form only if you intend importing controlled goods in terms of the Non- Proliferation of Weapons of Mass Destruction Act, 1993 (Act 87 of 1993). In terms of the Act all persons involved with controlled goods must register with the Council. You need to be registered before you can apply for an import permit. Application forms are available from the Secretariat. It is essential that you read the separate set of guidance notes before completing this form. Please answer all questions. The form will be returned to you if it has not been completed in full. 1 Registered person's name 2 Registration number 3 Address Postal code 4 Consignee's name 5 Address To facilitate optical character recognition this form must be typed. Only originals of this form are to be used. Postal Code 6 Nature of consignee's business Official use 7 Consignor's name 8 Address 9 Nature of consignor's business Date received 10 Name of end user (If not the same as the registered person). 11 Address PC Issue 1 Page 1 of 5

2 12 Nature of end user's business 13 If you have applied before to import any controlled goods/technology from the same source, state the previous permit number/s. 14 Name of agent/s involved (if applicable) 15 Address 16 Estimated date of shipment 17 Port of import Yes No 18 Will the goods be re-exported in any way? 19 What is the intended end use of the goods? PC Issue 1 Page 2 of 5

3 If the Secretariat wishes to discuss your application, who may be contacted? 20 Name 21 Street address 22 Telephone (including area code) 23 Fax (including area code) These goods will in no way be used for the development or production of nuclear, biological or chemical weapons or in systems capable of delivering such weapons. All provisions stated in Import Permit and the end-use/end-user certificate of the export country will be strictly adhered to. I hereby apply for an import permit in terms of the Non-Proliferation of Weapons of Mass Destruction Act, 1993 (Act 87 of 1993) for the goods listed in Part B of this form and declare that all the information furnished is correct. Name Signed (authorised signature for the registered person in Question 1) Date PC Issue 1 Page 3 of 5

4 PART B SCHEDULE OF GOODS and/or TECHNOLOGIES TO BE IMPORTED Please provide a full description of the controlled goods and/or technologies to be imported, including type, model and serial number where applicable. Full technical specifications of all the controlled goods and detailed descriptions of the controlled technologies must be provided on separate sheets attached to this application. Item Description of origin Quantit y Serial no The importer must adhere to the end-use requirements of the exporting country. The Council reserves the right to cancel, amend or suspend a permit that has been issued at any time. The import permit holder indemnifies the Council against any claim for loss or damage which the permit holder or any third party might suffer as a result of the issuing or withdrawal of such permit. An import permit shall not be transferable and the goods listed therein may only be imported by the stated person, firm or company from the country indicated therein. PC Issue 1 Page 4 of 5

5 GUIDANCE NOTES FOR COMPLETING THE IMPORT PERMIT APPLICATION In terms of the Non-Proliferation of Weapons of Mass Destruction Act, 1993, (Act 87 of 1993), all persons involved with controlled goods must register with the Council for the Non-proliferation of Weapons of Mass Destruction. Lists of controlled goods are published in the Government Gazette and may be updated from time to time. The Act also stipulates that permits are required before any controlled item can be exported, imported or transferred from one country to another country across the borders of the Republic of South Africa. Permits will be issued to registered persons only. All questions must be answered, unless otherwise indicated on the application form. If the answer is in the negative or not applicable, please state so. Use a separate sheet and attach it to the application form if the space for the answer is insufficient. The permit will be issued in the name of the registered person. It is important that the name and registration number corresponds with that on the registration certificate. The import permit will be sent to the registered person's address. The consignee may be the same as the person as the registered person or can be a division under the registered legal person. All previous permits for the same or similar goods from the same source must be listed under question 13. Full specifications of the controlled goods must be provided on separate sheets of paper attached to the application form. Controlled goods may be either a system, a subsystem of a product system, technology or production/test equipment. Further information and assistance can be obtained from the Secretariat at telephone , fax , or from postal address Private Bag X84, Pretoria, PC Issue 1 Page 5 of 5