Form DS-2032 Statement of Registration

Electronic Form Version Number 1.4 OMB APPROVAL NO. 1405-0002

EXPIRATION DATE: 9/30/2014

ESTIMATED BURDEN: 1 HOUR

*PAPER WORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 1 hour per response, including time required to search existing data sources, gather the necessary data, providing the information required, and reviewing the final collection. Send comments on the accuracy of this estimate of the burden and recommendations for reducing it to: Department of State (A/GIS/DIR) Washington, D.C. 20520.

(Note: Highlights denote new fields/text)

U.S. Department of State

DS-2032 STATEMENT OF REGISTRATION

(SEE INSTRUCTION PAGE)

For DDTC Use Only

D ate Received_______ PM/DDTC Registration Code(s) M______/ K-_____ Date Issued/Action Completed______

Summary of activity: M E B EB

1. Registrant is a U.S. Person? 2. Registration Action:

Yes No New Renewal

3. Registration Code(s) (If applicable include both M and K code) M_______ / K-________

4. Registrant’s Legal Name, Address, and Registration Type:

Registration Type (select all that apply):

Manufacturer/Exporter (U.S. Person) Manufacturer (U.S. Person)

Exporter (U.S. Person) Broker (U.S. Person)

Broker Foreign (Non-U.S.) Person

Legal Business Name: _____________________________________

“Doing Business As” Name: ____________________________________

Physical Street Address: ____________________________________

P.O. Box: ____________________________________

City: ____________________________________

State/Province: ____________________________________

Country: ____________________________________

Zip/Postal Code: ____________________________________

Telephone: ____________________________________

Fax: ____________________________________

Website: ____________________________________

5. Annual Registration Fee Amount:

New $_________ Payment Information

Renewal $_________ Effective Date of Electronic Payment:

Lapsed (see 22 CFR 122.3(c)) $_________ ______________________________

Non-Profit Fee Name on Account from Which Payment Drawn and Method (i.e., SWIFT, FEDWIRE or ACH):

(IRS Non-Profit Authorization must be provided) ______________________/___________

IRS Non-Profit Authorization Attached Last 5 Digits of the Account Number From Which Payment Drawn:

_____________________________

(Note: Payment must be drawn against the account of the registrant in Block 4. Payment must be in U.S. currency and must be payable through a U.S. financial institution.)

6. Registrant’s Organizational Type:

Corporation Company Limited Liability Company Partnership

Individual Owner Other (if other selected attach explanation)

Date of Incorporation or Date of Establishment of Business: (mm/dd/yyyy) _________

Place of Incorporation/Establishment of Business: (City or County, State, Country) ________

Documentation attached, issued by the government authority enabling Registrant to engage in business in the U.S. (e.g., Articles of Incorporation) or in a foreign country.

7. Members of the Board of Directors, Senior Officers, Partners and Owners: (Attachments not permitted)

Last Name: _____________ Citizenship(s): _______________

First Name: _____________ Social Security Number or Equivalent: _________

Middle Name: ___________ Position/Title: _______________

Date of Birth: ___________ Permanent Resident Card Number: ____________

Place of Birth Home Address

City: __________________ Street Address: ___________________________

State/Province: __________ Apt: ____________________________________

Country: _______________ City: ____________________________________

State/Province: ____________________________

Zip/Postal Code: ___________________________

Country: _________________________________

8. U.S. Munitions List Defense Articles or Defense Services Involved in Manufacturing, Exporting or Brokering: (Select all that apply)

I- Firearms, Close Assault Weapons and Combat Shotguns

II – Guns and Armament

III- Ammunition / Ordnance

IV – Launch Vehicles, Guided Missiles, Ballistic Missiles, Rockets, Torpedoes, Bombs and Mines

V – Explosives and Energetic Materials, Propellants, Incendiary Agents and their Constituents

VI – Vessels of War and Special Naval Equipment

VII – Tanks and Military Vehicles

VIII – Aircraft and Associated Equipment

IX – Military Training Equipment and Training

X – Protective Personnel Equipment and Shelters

XI – Military Electronics

XII – Fire Control, Range Finder, Optical and Guidance and Control Equipment

XIII – Auxiliary Military Equipment

XIV – Toxicological Agents, Including Chemical Agents, Biological Agents and Associated Equipment

XV – Spacecraft Systems and Associated Equipment

XVI – Nuclear Weapons, Design and Testing Related Items

XVII – Classified Articles, Technical Data and Defense Services Not Otherwise Enumerated

XVIII – Directed Energy Weapons

XIX – Reserved

XX – Submersible Vessels, Oceanographic and Associated Equipment

XXI – Miscellaneous Articles (you may only select this category if you have been granted a commodity jurisdiction ruling from State for your article)

9. Name(s) and Address(es) of Registrant’s Wholly-and Partially-Owned U.S. Subsidiaries / Affiliates / Joint Ventures in the Business of Manufacturing, Exporting or Brokering Defense Articles or Defense Services, if applicable: (Attachments not permitted)

None

1 Manufacturer / Exporter Broker (select all activities that apply)

Name Street Address City State/Province Zip/Postal Code Telephone

2 Manufacturer / Exporter Broker (select all activities that apply)

Name Street Address City State/Province Zip/Postal Code Telephone

3 Manufacturer / Exporter Broker (select all activities that apply)

Name Street Address City State/Province Zip/Postal Code Telephone

10. Name(s) and Address(es) of Registrant’s Wholly-and Partially-Owned Foreign Subsidiaries / Affiliates / Joint Ventures in the Business of Manufacturing, Exporting, or Brokering Defense Articles or Defense Services, if applicable: (Attachments not permitted)

None

1 Broker Exclusive Broker Manufacture / Exporter (select which applies)

Name Street Address City State/Province Zip/Postal Code Country Telephone

2 Broker Exclusive Broker Manufacture / Exporter (select which applies)

Name Street Address City State/Province Zip/Postal Code Country Telephone

3 Broker Exclusive Broker Manufacture / Exporter (select which applies)

Name Street Address City State/Province Zip/Postal Code Country Telephone

11. Name(s) and Address(es) of Registrant’s Foreign (Non-U.S.) Exclusive Brokers Not Wholly-or Partially-Owned Brokering Defense Articles or Defense Services, if applicable: (Attachments not permitted)

None

1 Name Street Address City State/Province Zip/Postal Code Country Telephone

2 Name Street Address City State/Province Zip/Postal Code Country Telephone

3 Name Street Address City State/Province Zip/Postal Code Country Telephone

12. Name, Address and Telephone Number of Registrant’s U.S. Ultimate Parent Company, and all Intermediary Parents: Note: If ultimate U.S. parent is a manufacture / exporter they must be the registrant in block 4. If this registration submission only involves brokers and ultimate U.S. parent is a broker (and you have no foreign ultimate parent who is a broker) then such parent must be the registrant listed in block 4.

None

Ultimate Parent:

Broker None (select which one applies)

Name Street Address City State/Province Zip/Postal Code Telephone

None

Intermediary Parent(s):

1 Manufacturer/ Exporter Broker None (select which applies)

Name Street Address City State/Province Zip/Postal Code Telephone

2 Manufacturer/ Exporter Broker None (select which applies)

Name Street Address City State/Province Zip/Postal Code Telephone

13. Name, Address and Telephone Number of Registrant’s Foreign (non-U.S.) Ultimate Parent Company, and all Intermediary Parents: Note: If this registration submission only involves brokers and ultimate foreign parent is a broker (not a foreign exclusive broker) then such parent must be the registrant listed in block 4.

None

Ultimate Parent:

Broker Exclusive Broker None (select which one applies)

Name Street Address City State/Province Zip/Postal Code Country Telephone

None

Intermediary Parent(s):

1 Broker Exclusive Broker None (select which one applies)

Name Street Address City State/Province Zip/Postal Code Country Telephone

2 Broker Exclusive Broker None (select which one applies)

Name Street Address City State/Province Zip/Postal Code Country Telephone

14. Statement of Registration Certification: (select (U.S. Manufacture / Exporter) and / or (U.S. / Foreign Broker / Report) as applicable)

U.S. Manufacturer / Exporter Certification:

Under penalty according to federal law (22 U.S.C. 2278-2780; 22 C.F. R. 120-130; 18 U.S.C. 1001)

I, warrant the truth of all statements made herein, together with any and all appendices and attachments thereto and I further warrant that:

In compliance with 22 C.F.R. 122 with reference to 22 C.F.R. 122.2(b)(1) and (b)(2), I hereby state that I am an authorized senior officer of the intended registrant and furthermore, I hereby provide the following answer to the questions of whether the intended registrant, chief executive officer, president, vice presidents, secretary, partner, member, other senior officers or officials (e.g., comptroller, treasurer, general counsel), or any member of the board of directors of the registrant or of its parent, subsidiary, joint venture, or other affiliate or other persons required to be listed in the Statement of Registration:

1. Has ever been indicted or otherwise charged (e.g., by information) for or convicted of violating any of the U.S. criminal statutes enumerated in §120.27 of this subchapter; or

2. Is ineligible to contract with, or to receive a license or other approval to import defense articles or defense services from, or to receive an export license or other approval from, any agency of the U.S. Government.

If the answer is YES to either statement, all details must be provided.

Yes No

Specify and attach appropriate documentation:

U.S. / Foreign (Non-US) Broker Certification / Report:

Under penalty according to federal law (22 U.S.C. 2278-2780; 22 C.F. R. 120-130; 18 U.S.C. 1001)

I, warrant the truth of all statements made herein, together with any and all appendices and attachments thereto and I further warrant that:

In compliance with 22 C.F.R. 129 with reference to 22 C.F.R. 129.4(c)(1) and (c)(2), I hereby state that I am an authorized senior officer of the intended registrant and furthermore, I hereby provide the following answer to the questions of whether the intended registrant, chief executive officer, president, vice presidents, secretary, partner, member, other senior officers or officials (e.g., comptroller, treasurer, general counsel), or any member of the board of directors of the registrant or of its parent, subsidiary, joint venture, or other affiliate or other persons required to be listed in the Statement of Registration:

1. Has ever been indicted or otherwise charged (e.g., by information) for or convicted of violating any of the U.S. criminal statutes enumerated in §120.27 of this subchapter or foreign criminal statutes dealing with subject matter similar to that in the U.S. criminal statutes enumerated in §120.27; or

2. Is ineligible to contract with, or to receive a license or other approval to import defense articles or defense services from, or to receive an export license or other approval from, any agency of the U.S. Government, or is ineligible to contract with, or to receive a license or other form of authorization or otherwise participate in export or brokering activities under the laws of a foreign country.

If the answer is YES to either statement, all details must be provided.

Yes No

Specify and attach appropriate documentation:

I Have Brokering Activity to Report (including successful / unsuccessful broker activity)

Yes No

Broker Report Attached: (covering all brokers listed except foreign exclusive brokers)

In accordance with 22 C.F.R. 122.2(b)(2) and 22 C.F.R. 129.4(c)(2), I further declare whether the intended registrant is owned or controlled by foreign (i.e., Non-U.S.) persons as defined in 22 C.F.R 120.16. If the answer is yes to the statement, all details must be provided including a detailed explanation of foreign ownership and control and information on the percentage of foreign ownership.

By Foreign Persons (i.e., Non-US.) (See 22.C.F.R. 120.16)

Yes No

If yes, see 22.C.F.R. 120.37 and specify and attach appropriate documentation.

O rganizational Chart Attached showing all intermediary layers of the organization through the ultimate parent (U.S. or Foreign) including all listed U.S. / Foreign subsidiaries and affiliates.

Senior Officer Signature: __________________________________________

Senior Officer Name: __________________________________________

Title: __________________________________________________________

Date: __________________________________________________________

Email: _________________________________________________________

DS-2032 STATEMENT OF REGISTRATION INSTRUCTIONS

General Notes:

1. Complete all Items. If “none” applies to an item, so indicate.

2. Only electronic payment will be accepted for registration fees.

3. Electronic payment must be in U.S. currency, payable through a U.S. financial institution. Cash, checks, foreign currency or money orders will not be accepted.

4. Attach an organization chart that shows all intermediary layers of the organization through the ultimate parent (U.S. or Foreign) identified in Block 12 or 13. The Chart should also show the entities identified in Blocks 9 and 10.

5. All relevant documentation must be provided with the form at the time of submission.

6. Attachments will not be accepted for Blocks 7, 9, 10, 11, 12 or 13. Requested information must be typed into the DS-2032 form.

7. Changes in certain information contained in this application must be reported promptly in accordance with 22 C.F.R. 122.4.

8. At renewal time, changes to information previously filed must be highlighted.

9. Company entities (e.g., subsidiaries, affiliates or joint ventures, etc.) may not register separately.

10. For assistance in completing this form, contact the DDTC Response Team at 202-663-1282 or by email at [email protected].

Block 1: U.S. person (as defined in ITAR Part 120.15) may register as Manufacture / Exporter and / or Broker. Foreign (non-U.S.) persons may only register as a Broker. In order for the registration submission to include manufacturer / exporter, Broker, and Exclusive Broker the registrant must be a U.S. person and be registered in block 4 as a Manufacture or Exporter. If a U.S. person is only registered in block 4 as a broker, or broker foreign (non-US) person is the registrant in block 4 then the registration submission may only include brokers (not Exclusive Brokers).

Block 2: Select as appropriate. For lapsed registrations, select renewal and see instructions for Block 5.

Block 3: For new registrations, leave blank. For renewal registration, enter DDTC registration manufacture / exporter / and/ or broker code(s) (e.g., M11111 and/ or K-1111) as applicable.

Block 4: Select all registration type(s) applicable for registrant. A post office box address should only be provided if the physical street address cannot accept mail deliveries. Foreign registrants must include country and city code when providing telephone and fax numbers.

Block 5:

1. Fee must be paid in U.S. currency through a U.S. institution drawn from the registrant’s account. Cash, check, foreign currency or money orders will not be accepted.

2. Registration fees must be paid via electronic payment. See detailed instructions at www.pmddtc.state.gov/registration. Registrants renewing their registration will be notified of the annual fee due, approximately 60 days prior to the expiration of the current registration.

3. For a lapsed registration when the intended registrant was engaged in the business of manufacturing, exporting or brokering defense articles or defense services, the intended registrant must pay back fees. Otherwise, the intended registrant must provide a written certification, signed by a senior officer, that the registrant was not engaged in the business during the lapsed period. Additional information on lapsed fees and calculating lapsed fees are available at www.pmddtc.state.gov/registration.

4. Registrants who are wholly exempt from income taxation pursuant to 26 U.S.C. 501(c)(3) may be reduced to the first tier registration fee provided proof of such status (i.e., IRS certification form) is submitted with their registration package. The IRS certification must apply to all entities / subsidiaries / affiliates listed in the registration submission.

5. For Effective Date of Electronic Payment, enter the date in which the payment is scheduled to be received by the U.S. Government. If necessary, contact your financial institution for assistance in obtaining the effective payment date.

Block 6: Select as appropriate. New and renewal registrants must attach documentation issued or endorsed by the government authority enabling registrant to engage in business in the U.S. (e.g., articles of incorporation, articles of organization or partnership agreement) or in a foreign country. Note: the legal name provided in the documentation must be used in block #4 by the registrant.

Block 7: Do not provide the requested information in an attachment. Information must be typed into the DS-2032. Provide all required data, including home address and country(s) of citizenship. If foreign citizenship is listed, but the senior officer, director or owner holds U.S. Permanent residency, provide a copy of the U.S. Government issued permanent resident card.

Block 8: Must select at least one USML category.

Block 9: Do not provide the requested information in an attachment. Information must be typed into the DS-2032. Check blocks indicating applicable defense activities (i.e. Manufacturer; Exporter; Broker). Provide only U.S. subsidiaries / affiliates / joint ventures, wholly or partially owned by the registrant that are engaged in manufacturing / exporting or brokering defense articles or defense services.

Block 10: Do not provide the requested information in an attachment. Information must be typed into the DS-2032. Check blocks indicating applicable defense activities (i.e., Broker or Exclusive Broker). Provide only foreign subsidiaries / affiliates / joint ventures, wholly or partially owned by the registrant that are engaged in brokering defense articles or defense services.

Block 11: Do not provide the requested information in an attachment. Information must be typed into the DS-2032. If you wish your exclusive broker(s) to be covered under your registration, then provide all of your third party brokers who are exclusively brokering only for you (and not brokering for any other U.S. or Foreign person and otherwise meet the requirements of ITAR Part 129.3(b)(3)) that are engaged in brokering defense articles or defense services. Your third party exclusive broker(s) not covered under your registration must register separately as a broker, pay the applicable registration fee, and is subject to all prior approval, reporting, and recordkeeping requirements.

Block 12. Do not provide the requested information in an attachment. Information must be typed into the DS-2032. If you have no U.S. parent and / or intermediary parent, select none. If you have a U.S. parent and / or intermediary parent(s), then select blocks indicating activity or “none” meaning not engaged in defense business activity. Note: Where ultimate U.S. parent is a manufacture / exporter they must be listed in block 4 as the registrant. If this registration submission only covers brokers and the ultimate parent is a broker, then parent must be listed in block 4 as the registrant.

Block 13. Do not provide the requested information in an attachment. Information must be typed into the DS-2032. If you have no foreign parent and /or intermediary parent, select “none.” If you have a foreign parent and / or intermediary parent(s), then select block indicating if parent is a broker or exclusive broker. Select “none” if your parent is not engaged in defense business activity.

Block 14. Select and complete manufacture / exporter and /or broker certification for all registration type(s) represented in the form as applicable. A senior officer (e.g., chief executive officer, president, comptroller, treasure, general counsel must sign the registration submission. A senior officer is a person who has executive level responsibilities of the registrant. The individual signing this form must be a Senior Officer empowered by the registrant. The Senior Officer signing must be a U.S. person unless registering as a broker.

Registered and Express Mailing Address (Express Mailing Recommended)

U.S. Department of State

Directorate of Defense Trade Controls

Compliance and Registration Division

2401 E Street, NW, SA-1, Room H1200

Washington, DC 20037

Privacy Act Statement

AUTHORITIES: U.S. Department of State’s authorities to register persons engaged in the business of manufacturing, exporting or importing any defense article or defense service are 22 U.S.C. 2778(b)(1)(A)(i) and 22 CFR Part 122. The authorities to register brokers are 22 U.S.C. 2778(b)(1)(A)(ii)(I) and 22 CFR §§129.3 and 129.4. The authority to solicit Social Security numbers is Executive Order 9397.

PURPOSE: The purpose of registration is to provide the U.S. Government with necessary information on individuals and entities engaged in certain manufacturing, exporting and brokering activities.

ROUTINE USES: The information solicited on this form is made available to appropriate agencies for law enforcement or pursuant to a court order. It may also be used to send required reports to Congress about certain defense transactions.

SOCIAL SECURITY NUMBER: Disclosure of the Social Security number(s) is voluntary and for the purpose of facilitating coordination with the Department of Homeland Security to review the registration statement for law enforcement concerns in accordance with 22 U.S.C. 2778(b)(1)(B). Refusal to provide requested Social Security number, by itself, will not result in registration being denied, but may result in delays in U.S. Government action on the registration request.

DS-2032