Regulation (EU) 2021/821 of the European Parliament and of the Council of 20 May 2021 setting up a Union regime for the control of exports, brokering, technical assistance, transit and transfer of dual-use items (recast)
Annex III - Models for authorisation forms
A. Model for individual or global export authorisation forms
(referred to in Article 12(2) of this Regulation)
When granting the export authorisations, Member States will strive to ensure the visibility of the nature of the authorisation (individual or global) on the form issued.
This export authorisation is valid in all Member States of the European Union until its expiry date.
|
EUROPEAN UNION |
EXPORT OF DUAL-USE ITEMS (Reg. (EU) 2021/821) |
|||||
|
1 |
1. Exporter |
No |
2. Identification number |
3. Expiry date (if applicable) |
||
|
LICENCE |
|
4. Contact point details |
||||
|
5. Consignee |
6. Issuing authority |
|||||
|
7. Agent/Representative (if different from exporter) |
No |
|||||
|
|
8. Country of consignment |
Code |
||||
|
9. End-user (if different from consignee) |
10. Member State of current or future location of the items |
Code |
||||
|
11. Member State of intended entry into the customs export procedure |
Code |
|||||
|
1 |
12. Country of final destination |
Code |
||||
|
13. Description of the items ( 1 ) |
14. Country of origin |
Code 2 |
||||
|
15. Harmonised System or Combined Nomenclature Code (if applicable with 8 digit; CAS number if available) |
16. Control list No (for listed items) |
|||||
|
17. Currency and Value |
18. Quantity of the items |
|||||
|
19. End-use |
20. Contract date (if applicable) |
21. Customs export procedure |
||||
|
22. Additional information required by national legislation (to be specified on the form) |
||||||
|
Available for pre-printed information At discretion of Member States |
||||||
|
|
For completion by issuing authority Signature Issuing Authority |
Stamp |
||||
|
|
|
Date |
|
|||
|
1 Bis |
1. Exporter |
2. Identification number |
|
|||
|
LICENCE |
|
|
|
|||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code (if applicable with 8 digit; CAS number if available) |
16. Control list No (for listed items) |
|||||
|
17. Currency and Value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code (if applicable with 8 digit; CAS number if available) |
16. Control list No (for listed items) |
|||||
|
17. Currency and Value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
13. Description of the items |
14. Country of origin |
Code 2 |
||||
|
15. Commodity code |
16. Control list No |
|||||
|
17. Currency and value |
18. Quantity of the items |
|||||
|
Note: In part 1 of column 24, write the quantity still available and in part 2 of column 24, write the quantity deducted on this occasion. |
||||||
|
23. Net quantity/value (Net mass/other unit with indication of unit) |
26. Customs document (Type and number) or extract (No) and date of deduction |
27. Member state, name and signature, stamp of deduction |
||||
|
24. In numbers |
25. In words for quantity/value deducted |
|
|
|
|
|
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
|
|||
|
1. |
|
|
|
|
|
|
|
2. |
|
|
||||
|
If needed, this description may be given in one or more attachments to this form (1bis). In this case, indicate the exact number of attachments in this box. The description should be as precise as possible and integrate, where relevant, the CAS or other references for chemical items in particular. |
|
|
||||
B. Model for brokering services / technical assistance authorisation forms
(referred to in Article 13(5) of this Regulation)
|
EUROPEAN UNION |
PROVISION OF BROKERING SERVICES / TECHNICAL ASSISTANCE (Reg. (EU) 2021/821) |
|
|||
|
1 |
1. Broker/ Provider of technical assistance/ Applicant |
No |
2. Identification number |
3. Expiry date (if applicable) |
|
|
LICENCE |
4. Contact point details |
|
|||
|
5. Exporter in originating third country (if applicable) |
6. Issuing authority |
|
|||
|
7. Consignee |
No |
|
|||
|
8. Member State in which the broker / provider of technical assistance is resident or established |
Code ( 1 ) |
|
|||
|
9. Originating country/ Country of location of the items subject of brokering services |
Code ( 1 ) |
|
|||
|
10. End-user in third country of destination (if different from consignee) |
11. Country of destination |
Code ( 1 ) |
|
||
|
12. Third parties involved, e.g. agents (if applicable) |
|
|
|||
|
1 |
|
|
|
||
|
13. Description of the items / technical assistance. |
14. Harmonised System or Combined Nomenclature Code (if applicable) |
15. Control list No (if applicable) |
|
||
|
16. Currency and Value |
17. Quantity of the items (if applicable) |
|
|||
|
18. End-use |
|
||||
|
19. Additional information required by national legislation (to be specified on the form) |
|
||||
|
Available for pre-printed information At discretion of Member States |
|
||||
|
|
For completion by issuing authority Signature Issuing Authority |
Stamp |
|
||
|
|
|
Date |
|
|
|
|
See Regulation (EC) No 1172/95 (OJ L 118, 25.5.1995, p. 10). |
|
||||
C. Common elements for publication of national general export authorisations in national Official Journals
(referred to in point (b) of Article 12(6) of this Regulation)
1. Title of the national general export authorisation
2. Authority issuing the authorisation
3. EU validity. The following text shall be used:
‘This is a national general export authorisation under the terms of Article 12(6) of Regulation (EU) 2021/821. This authorisation, in accordance with Article 12(6) of that Regulation, is valid in all Member States of the European Union.’
Validity: according to national practices.
4. Items concerned: the following introductory text shall be used:
‘This export authorisation covers the following items’
5. Destinations concerned: the following introductory text shall be used:
‘This export authorisation is valid for exports to the following destinations’
6. Conditions and requirements