Form DS-6001 U.S. DEPARTMENT OF STATE DIRECTORATE OF DEFENSE TRADE CO

Electronic Form Version Number: 0.15
OMB APPROVAL NO. 1405-0174
EXPIRATION DATE: ????
*ESTIMATED BURDEN: 1 Hour
* PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 1 hour per response, including
time required for searching existing data sources, gathering 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.

U.S. DEPARTMENT OF STATE
DIRECTORATE OF DEFENSE TRADE CONTROLS
REQUEST FOR ADVISORY OPINION

*Transaction Number:

Please note that an Asterisk (*) next to a field or block in a document designates a mandatory field or block.

No classified information can be included in this request. Classified information must be sent
separately to DDTC in accordance with the Defense Security Service guidelines.
Classified information is being sent under separate cover

To open a document, click on a document to highlight it and select the "Open Document" button. The document that
you selected will open.
Included Documents

Required Documents
DS-6001

Open Document
Optional Documents
126.13 Eligibility Letter
Other Amplifying Documents
Transaction Exception Request
Open Document

Open Document

DS-6001
MM-YYYY Revised

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DATE RECEIVED: 02/15/2005
CASE NO.

UNITED STATES OF AMERICA DEPARTMENT OF STATE

REQUEST FOR ADVISORY OPINION
* 1. Date Prepared

02/15/2005

2. DDTC Applicant/Registrant Code
4. Names, agency and telephone numbers of U.S. Government
personnel (not DDTC) familiar with the request

3. Applicant Name, Address, ZIP Code and Tel. No.
Subsidiary

Name
*Name

Agency

Agency

Please Specify
Ext

Telephone #

*Attention

Add More Government Contacts

*Address

5. Name and telephone number of applicant contact(s)
*City

Name

State

* State

*ZIP Code

Telephone #
Ext.

*Telephone #

Add More Contacts

*7. Name, address, role of foreign intermediate(s) and nationality if
not of country identified

*6. Country(s) of Ultimate Destination

Country

View
Full
List

<==

Ext

None
This foreign intermediate is a

Foreign Intermediate Identity

Name

*8. Name and address of foreign end-user(s)
Name

Address
City

Address

Country

Country

Role

City
Country

Country

Add More Foreign End-Users

Nationality of foreign intermediate

Country

Add More Foreign Intermediates

Line
Item
#
1

*9. Defense Article type

*10. Quantity

*11. Commodity

Defense Article Type

*13. Envisioned transaction
type

12. USML Cat. Number

*Category
Unit Type

*Sub

Commodity Code
14. $ Value

Transaction Type

Unit Price

*Line Item Total

If Temporary Import or In
Transit, being shipped from
Calculate

Country

Add More Items

* 15. TOTAL VALUE (Sum of All Pages) $

0

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Case No.
*16. Identify highest government security classification of the commodity that is the subject of this request (NOTE: Do not include classified
information)
a. The highest level of U.S. Government Security Classification is

Classification

b. If a commodity is produced in a foreign country, is it government classified?

*17. Specific Purpose/End Use of Defense Article(s)
Request for Prior Approval (22 CFR 126.8)

View Full Description

18. Additional Details of Transaction

View Full Description

Yes

No

If yes, provide details in Block 18.

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Case No.

* 19. Applicant's statement (see instructions)
, an empowered official (ITAR 120.25) or an official of a foreign government entity in the U.S., hereby request

I,

an advisory opinion on the transaction above; warrant the truth of all statements made herein; and acknowledge, understand and will comply with the
provisions of Title 22 CFR 120-130, and any conditions and limitations imposed.
I am authorized by the applicant to certify the following in compliance with 22 CFR 126.13:
(1)

Neither the applicant, its chief executive officer, president, vice presidents, other senior officers or officials (e.g., comptroller, treasurer, general
counsel) nor any member of its board of directors is:
(a) the subject of an indictment for or has been convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR120.27 since the
effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 (June 30, 1976); or
(b) 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;

(2)

To the best of the applicant's knowledge, no party to the export as defined in Section 126.7 (e) has been convicted of violating any of the U.S.
criminal statutes enumerated in 22 CFR 120.27 since the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729
(June 30, 1976), or 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; and

22 CFR 126.13 Certification Mandatory for 22 CFR 126.8 (Select one)
I am authorized by the applicant to certify that the applicant and all the parties to the transaction can meet in full the conditions of 22 CFR 126.13
as listed above.
I am authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of the parties of the transaction cannot meet one or more of
the conditions of 22 CFR 126.13 as listed above. A request for an exception to policy is attached.
I am not authorized by the applicant to certify the conditions of 22 CFR 126.13 as listed above. The applicant and all the parties to the transaction
can meet in full the conditions of 22 CFR 126.13 as listed above. Please see the attached letter for such certification.
I am not authorized by the applicant to certify the conditions of 22 CFR 126.13 as listed above. The applicant or one of the parties of the
transaction cannot meet one or more of the conditions of 22 CFR 126.13 as listed above. A letter of such certification and request for an
exception to policy is attached.
Signature

Signature

20. Response to be sent to (Enter name, address and tel. no.)

[Block is inactive on electronic form]
Same as Block 3

Hold for Pickup

Name

Attention
Address
City
State
Country
Telephone #

State

Zipcode

Country
Ext.

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Subsidary Information under Block 3, Page one of DS-6001
Name

Attention
Address
City
State
Telephone #

State

Zipcode
Ext.

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