SCHEDULE "C"

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Following your completion of this Schedule:
click here or go to www.securesearchinc.com/send.htm
for instructions on how to send this
form to us.  Thank you.

SECURESEARCH, INC.

SCHEDULE “C”  

END-USER CERTIFICATE
(REQUIRED BY THE GOVERNMENT OF CANADA, DEPARTMENT OF FOREIGN AFFAIRS AND INTERNATIONAL TRADE, EXPORT CONTROLS DIVISION, OTTAWA, ONTARIO, CANADA)

When completed signed and sworn, this is a legal document required for supervision and control of international trade in regulated products. Violation of government regulations may result in severe penalties and sanctions being imposed in breach of national and international laws! Two copies of this document are to be returned to SECURESEARCH, INC. or to our authorized sales representative by registered mall, before any goods can be shipped. In certain cases, based on the information in this certificate, shipment may require issuance of a federal export certificate or approval by the U.S. Department of Commerce. 

1. Name of Canadian exporter (Securesearch, Inc. or):   Securesearch, Inc.

2. Name of Importer:________________________________________________

Address:_________________________________________________________

Telephone number including country code and area code:__________________

Fax number of Importer: ___________________          E-mail address:_________________________________

3. (U.S.A. purchasers ONLY) MANDATORY I.R.S. Employer Tax ID no.(EIN) if importer is a company or agency:

Social Security Number if importer is an individual:_____________________________

4. If importer is purchasing for sale to an authorized third party, provide the name, address, phone number, fax number of the third party:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

(in the U.S.A. please provide the third party Federal Employer ID no. or Social Security Number):

5. If goods are to be exported to a THIRD country, provide name and address of exporter:

Name & address of third country IMPORTER, if applicable: ___________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

6. END-USER IDENTIFICATION

Name of company or government agency/dept. designated as the end-user (final purchaser) of these goods:

_____________________________________________________________________________________________

Division:________________________ Phone number:___________________ Phone ext. no. if applicable:_______

Fax number:_______________________  E-mail address:______________________________________________

Full street address of end user (Not a post office box no.):______________________________________________

______________________________________________________________________________________________

P.O. Box no.:______________      City:__________________  Country:____________________ 

Postal Code:____________________

7. Brief description of goods purchased:_____________________________________________________________

______________________________________________________________________________________________

8. End use purpose for which goods are being purchased:______________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Purchase order no.:__________________________________

9. Affirmation: "I certify that the Securesearch, Inc. products described above are only for use in (country name):

and will not be exported to any other country. We are the end-user".

________________________________________________________________________
AUTHORIZED SIGNATURE                        (PRINT OR TYPE YOUR NAME)                       TITLE

________________________________________________________________________
Witness name                                          Witness Signature                                               Date

Affix official stamp or seal of witness taking sworn oath here:

Following your completion of this Schedule:
go to www.securesearchinc.com/send.htm
for instructions on how to send this
form to us.  Thank you.
End of Schedule "C"   
(Rev. 10-11/2007)