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Service Request Form Sea-Bird GmbH End User CertificateDeclaration of Contamination
To return instruments for calibration or other service, please provide the information below to prevent delays in the return of the instruments:
• Get a Returned Material Authorization (RMA) number from Sea-Bird GmbH ([email protected], phone +49 (0) 831 / 960994-701). Reference the RMA number on this form, on the outside shipping label and in all related correspondence.
• Fill in the contact fields and include this form when shipping the instruments to Sea-Bird GmbH, Ludwigstr. 16, 87437 Kempten Germany.• E-mail a copy of this form on the day you ship. [email protected]
Invoicing addressBusiness- / Institution name
Contact name, secondary Contact name
Shipping address
Shipping instructions:VAT ID
Contact E-mail, secondary E-mail
Contact phone number
RMA Number Requested return date Purchase Order Number
Quote before repairs Send paper copies of documents Return job only completed
_____________________________________________________________________________________________
_____________________________________________________________________________________________
1 von 3 SRF:V3.2
End User's Address and Country
Shipping Route of returned Equipment to Kempten
End User Type of Business
Ultimate End Use
Continue with repairs Send only digital copies of documents Split job and return units when completed
Business- / Institution name End User
Contact E-mail End User, secondary E-mail End User
Contact Name End User, secondary Name End User
Contact phone number End User
VAT ID End User
3 von 3
• For the safety of our employees and compliance with legal regulations, please complete this Declaration of Contamination.All devices are decontaminated (cleaned) by Sea-Bird GmbH on receipt, if required.In cases of heavy soiling/ contamination, there is an extra charge for cleaning.
• A copy of the declaration must be attached in a visible way outside thepacking. This declaration must be fully completed and signed by an authorized member of your company/institution before your shipment will be processed.
If yes, please name all substances with which the device/s was in contact:no Toxic Acrid Explosive Radioactive Biological (Sludge, Mussels, Barnicles etc.)
yes
• We herewith confirm that we have completed this declaration fully, truthfully and to the best of our knowledge. Shipment is made in compliance with all legal regulations that apply to packaging, shipping and labelling of dangerous substances. The sender will be liable for any damages that occur caused by failure to declare and to markcontamination of the sent in devices.
• We understand that the Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and related technical data are subject to U.S. exportcontrol regulations and/or export or import regulations in other countries, agree to abide by U.S. export control regulations with respect to Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, and understand that we may be subject to fines and penalties for noncompliance with U.S. law and regulations.
• We will not, except as specifically authorized by U.S. Government regulation or export license:o use or transfer Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data for use in the design,
development, fabrication, or testing of nuclear weapons or explosive devices; or design, construction, fabrication, or operation of facilities or components of facilities for chemical processing of irradiated special nuclear or source material, heavy water production, separation of isotopes of source and special nuclear material, or fabrication of nuclear reactor fuel containing plutonium, or unsafeguarded nuclear facilities;
o use or transfer Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data for use in the design,fabrication, operation, or maintenance of certain rocket systems (including ballistic missile systems, space launch vehicles, and sounding rockets); or unmanned air vehicle systems (including cruise missile systems, target drones, remotely piloted vehicles, and reconnaissance drones);
o use or transfer Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data for use in the design, development, production, stockpiling or use of chemical or biological weapons;
o use or transfer Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data in support of deepwater(greater than 500 feet), Arctic offshore, or shale exploration or production projects that have the potential to produce oil and which involve any Russian entity that is subject to Executive Order 13662, Directive 4, as amended by Countering America's Adversaries Through Sanctions Act (Aug. 2, 2017; 131 Stat. 886).
o transfer, or facilitate the transfer of, Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data to anyperson, entity, organization or other party identified on a U.S. governmentissued restricted party list, including but not limited to the U.S. Department of Commerce’s Entity List, Unverified List or Denied Persons List; the U.S. Department of Treasury’s Specially Designated Nationals and Sectoral Sanctions Identifications lists; or the U.S. Department of State’s Nonproliferation Sanctions list;
o transfer, or facilitate the transfer of, Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data to anyU.S. sanctioned or embargoed country including but not limited to the geographic area of Crimea, Cuba, Iran, North Korea, Sudan or Syria.
o otherwise re‐export, resell, transfer, or make other disposition of Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and/or related technical data, except in accordance with the provisions of this Certification and all applicable export control and sanctions laws and regulations, as amended from time to time.
• I certify that (a) all of the facts contained in this Assurance are true and correct to the best of my knowledge and belief, (b) we will adhere to the conditions detailed herein, and (c) I have the lawful authority to sign this document on behalf of the below listed entity.
Were the devices flushed out and are they free from hazardous substances? no yes _____________________________________________________________________________________________
Legally binding declaration:
Sea‐Bird Scientific (Sea‐Bird Electronics, WET Labs, and Satlantic) products, software and related technical data are subject to U.S.export control regulations. In accordance with such regulations, buyer and end user of this equipment provides the followingassurances:
NAME
TITLE
LOCATIONDATE
AUTHORIZED SIGNATURE / COMPANY STAMP
I have read and agree to the Sea-Bird Scientific Export Control and End-Use Assurance Agreement
I confirm that I have reviewed and agree with Sea-Bird Scientific's Privacy Policy (www.seabird.com/privacy). I also understand my privacy choices as they pertain to my personal data as provided in the Sea-Bird Scientific Privacy Policy under "Your Privacy Choices"
I give Sea-Bird Scientific permission to provide me with information about their products and services, and related products and services form Sea-Bird's affiliates
