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pdfOMB APPROVAL NO. ####-####
EXPIRATION DATE: XX/XX/XXXX
*ESTIMATED BURDEN: 2 HOURS
U.S. Department of State
DS-2032: Statement of Registration
(SEE INSTRUCTIONS)
*PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 2 hours 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.
1. General Information
Applicant is a U.S. Person:
Yes
No
2. Registration Information
Registration Action:
New
Renew
Registration Code (if applicable):
Amend
Cancel
______________________
Add
Add
Registration Type:
Manufacturer
Exporter
Broker
FMS Freight Forwarder (Exporter)
One Time Exemption
U.S. Government
Foreign Government
If Registration Type is “FMS Freight Forwarder (Exporter)”
Authorized Countries:
_________________________________________
Add
Add
If Registration Type is “Foreign Government”
Designate an FMS Freight Forwarder
If Designate an FMS Freight Forwarder is checked
FMS Freight Forwarder
Legal Name:
_____________________________________
Subsidiary/Affiliate Legal Name (if applicable):
_____________________________________
Registration Code (if known):
____________________
Contract Duration (if known):
____________________
Point of Contact
First Name:
________________________________________________________________________
Last Name:
________________________________________________________________________
Telephone:
________________________________________________________________________
Email:
________________________________________________________________________
Add
Add
If Registration Action is “Cancel”
Applicant is notifying DDTC that it intends to let its manufacturing, exporting, brokering, or FMS freight forwarder registration
lapse. At the end of the registration period, it will no longer be in the business of
brokering, or
manufacturing,
exporting,
FMS freight forwarding (exporting) defense articles or defense services. The applicant will no longer
receive renewal notices for the applicable registration.
If Registration Action is “Renew”
If renewing a lapsed registration
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Page 1 of 9
Did you conduct any ITAR business during the lapse?
Yes
No
Lapsed Registration ITAR Activity Dates
Start Date:
_____________________
End Date:
Add
Add
_____________________
Has a voluntary disclosure been submitted regarding the conduct of ITAR business during the lapse?
Yes
No
If Registration Type is “Broker”
Does the applicant have brokering activity to report (including successful/unsuccessful broker activity)?
Yes
No
If Registration Action is “Amend”
Does the amendment involve a material change to the registration?
Yes
No
If Does the amendment involve a material change to the registration is “Yes”
Material Change Type:
Merger
Acquisition
Divestiture
Criminal Charge
Address
Legal Organizational Structure
Eligibility
Name
Directors, Senior Officers, Partners, and/or Owners
Establishment/Addition of Subsidiary/Controlled Affiliate
Notification Triggering Event Date:
_____________________
Summarize the essentials of the transaction, including a statement of purpose and description of scope with an explanation
of actions taken/to be taken inside and outside the U.S.:
3. Foreign Ownership/Control Information
A foreign person owns, or foreign persons own, more than 50% of the outstanding voting securities or equity of the applicant.
Yes
No
A foreign person has, or foreign persons have, the authority and/or the ability to establish or direct the general policies or dayto-day operations of the applicant.
Yes
No
A foreign person owns, or foreign persons own, 25% or more of the outstanding voting securities or equity and no other person
controls an equal or larger percentage.
Yes
No
Foreign persons (including foreign governments) from countries specified in 22 CFR 126.1 have the authority and/or ability to
establish and/or direct the general policies and/or day-to-day operations of the applicant.
Yes
No
Foreign persons (including foreign governments) from countries specified in 22 CFR 126.1 own more than 5% of the
outstanding voting securities or equity of the applicant.
Yes
No
4. Organization Type Information
Organization Type:
Corporation
Limited Liability Company
Educational Institution Nonprofit
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Partnership
Sole Proprietorship
Individual
Other
Page 2 of 9
Date of Incorporation or Business Commencement (if applicable):
_____________________
Place of Incorporation or Business Commencement (if applicable)
City:
________________________________________________________________________
Country:
________________________________________________________________________
State/Province:
________________________________________________________________________
The applicant has only a foreign parent (or foreign parents) and intends to list at least one affiliate.
Yes
No
5. Identifying Information
Applicant Type:
Natural Person
Entity
Applicant Legal Name and Address
If Applicant Type is “Natural Person”
First Name:
________________________________________________________________________
Middle Name:
__________________________________________________________
Last Name:
________________________________________________________________________
None
If Applicant Type is “Entity”
Company/Organization Name:
________________________________________________________________________
Doing Business As:
________________________________________________________________
Address Line 1:
________________________________________________________________________
Address Line 2:
________________________________________________________________________
Address Line 3:
________________________________________________________________________
City:
________________________________________________________________________
Country:
________________________________________________________________________
State/Province:
________________________________________________________________________
ZIP/Postal Code:
________________________________________________________________________
Website:
_________________________________________________________________________
Add
Add
Mailing address is the same as legal address
If Mailing address is the same as legal address is not checked
Mailing Address
Address Line 1:
________________________________________________________________________
Address Line 2:
________________________________________________________________________
Address Line 3:
________________________________________________________________________
City:
________________________________________________________________________
Country:
________________________________________________________________________
State/Province:
________________________________________________________________________
ZIP/Postal Code:
________________________________________________________________________
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Point of Contact
Point of Contact Type:
Applicant
Third Party
If Point of Contact Type is “Third Party”
Company/Organization Name: _______________________________________________________________________
First Name:
_______________________________________________________________________
Last Name:
_______________________________________________________________________
Position/Title:
_______________________________________________________________________
Telephone:
_______________________________________________________________________
Email:
_______________________________________________________________________
Add
Add
6. Members of the Board of Directors, Senior Officers, Partners and Owners
Board Member/Officer/Partner/Owner
Member Type:
Natural Person
Entity
U.S. Person:
Yes
No
Position/Title:
_______________________________________________________________________
If Member Type is “Natural Person”
First Name:
_______________________________________________________________________
Middle Name:
__________________________________________________________
Last Name:
_______________________________________________________________________
Citizenship:
________________________________________________________________
Date of Birth:
_______________________________________________________________________
Birth Country:
_______________________________________________________________________
Country of Residence:
_______________________________________________________________________
Telephone:
_______________________________________________________________________
Email:
_______________________________________________________________________
None
Add
If Member Type is “Entity”
Company/Organization Name: _______________________________________________________________________
Doing Business As Name:
_______________________________________________________________________
Address Line 1:
_______________________________________________________________________
Address Line 2:
_______________________________________________________________________
Address Line 3:
_______________________________________________________________________
City:
_______________________________________________________________________
Country:
_______________________________________________________________________
State/Province:
_______________________________________________________________________
ZIP/Postal Code:
_______________________________________________________________________
Point of Contact
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First Name:
_______________________________________________________________________
Last Name:
_______________________________________________________________________
Telephone:
_______________________________________________________________________
Email:
_______________________________________________________________________
Has been indicted or otherwise charged (e.g., charged by criminal information in lieu of indictment) for or convicted of
violating any of the U.S. criminal statuses enumerated in 22 CFR 120.27 or violating a foreign criminal law on exportation of
defense articles where convicted of such violation carries a minimum term of imprisonment of greater than 1 year.
Yes
No
Add
7. U.S. Munitions List Categories
U.S. Munitions List categories relevant to the applicant’s manufacturing, exporting, and/or brokering activities:
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
Surface Vessels of War and Special Naval Equipment
VII
Ground Vehicles
VIII
Aircraft and Related Articles
IX
Military Training Equipment
X
Personal Protective Equipment
XI
Military Electronics
XII
Fire Control, Laser, Imaging and Guidance Equipment
XIII
Materials and Miscellaneous Articles
XIV
Toxicological Agents, Including Chemical Agents, Biological Agents, and Associated Equipment
XV
Spacecraft and Related Articles
XVI
Nuclear Weapons Related Articles
XVII
Classified Articles, Technical Data, and Defense Services Not Otherwise Enumerated
XVIII
Directed Energy Weapons
XIX
Gas Turbine Engines and Associated Equipment
XX
Submersible Vessels and Related Articles
XXI
Articles, Technical Data, and Defense Services Not Otherwise Enumerated
If U.S. Munitions List categories relevant to the applicant’s… is “XXI”
Applicable Commodity Jurisdiction Number:
_________________________________
Add
Add
8. Affiliate/Subsidiary Information
Does the applicant own, or otherwise control, any U.S. or foreign affiliates or subsidiaries in the business of manufacturing,
exporting, and/or brokering defense articles or services?
Yes
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No
Page 5 of 9
If Does the applicant own, or otherwise control, any U.S. or foreign affiliates or subsidiaries… is “Yes”
Affiliate/Subsidiary
Activity Type:
Manufacturer
Exporter
Broker
FMS Freight Forwarder (Exporter)
Company/Organization Name: ________________________________________________________________________
Doing Business As Name:
________________________________________________________________________
Address Line 1:
________________________________________________________________________
Address Line 2:
________________________________________________________________________
Address Line 3:
________________________________________________________________________
City:
________________________________________________________________________
Country:
________________________________________________________________________
State/Province:
________________________________________________________________________
ZIP/Postal Code:
________________________________________________________________________
U.S. Person:
Yes
No
Relationship:
Affiliate
Subsidiary
If Relationship is “Affiliate”
Applicant has authority and/or ability to establish or direct the general policies or day-to-day operations of the affiliate.
Yes
No
Applicant owns 25% or more of the affiliate’s outstanding voting securities or equity and no other person controls an equal
or larger percentage.
Yes
No
A foreign person from a country specified in 22 CFR 126.1 has, or foreign persons from 22 CFR 126.1 countries have, the
authority and/or ability to establish and/or direct the general policies and/or day-to-day operations of the affiliate.
Yes
No
A foreign person from a country specified in 22 CFR 126.1 controls, or foreign persons from 22 CFR 126.1 countries
control, more than 5% of the affiliate’s voting securities.
Yes
No
Separate Point of Contact for Affiliate/Subsidiary
If Separate Point of Contact for Affiliate/Subsidiary is checked
Point of Contact
First Name:
________________________________________________________________________
Last Name:
________________________________________________________________________
Position/Title:
________________________________________________________________________
Telephone:
________________________________________________________________________
Email:
________________________________________________________________________
If Registration Action is “Renew” and Activity Type is “Broker”
Does the affiliate/subsidiary have brokering activity to report (including successful/unsuccessful broker activity)?
Yes
No
If Registration Action is “Renew” or “Amend” and an Affiliate/Subsidiary is Added or Removed
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Select reason for Adding or Removing Affiliate/Subsidiary:
_____________________________________________
If reason selected is Merger, Acquisition or Divestiture, did you submit, as appropriate, 60 day pre-notification/5 day MAD
material change notification letters?
Yes
No
Add
9. Parent Information
Does the applicant have any parent entities (U.S. and foreign, intermediate and ultimate)?
Yes
No
If Does the applicant have any parent entities (U.S. and foreign, intermediate and ultimate) is “Yes”
Parent Entity
Company/Organization Name: ________________________________________________________________________
Doing Business As Name:
________________________________________________________________________
Address Line 1:
________________________________________________________________________
Address Line 2:
________________________________________________________________________
Address Line 3:
________________________________________________________________________
City:
________________________________________________________________________
Country:
________________________________________________________________________
State/Province:
________________________________________________________________________
ZIP/Postal Code:
________________________________________________________________________
Separate Point of Contact for Parent
If Separate Point of Contact for Parent is checked
Point of Contact
First Name:
________________________________________________________________________
Last Name:
________________________________________________________________________
Position/Title:
________________________________________________________________________
Telephone:
________________________________________________________________________
Email:
________________________________________________________________________
Parent Status:
Ultimate
Intermediate
U.S. Person:
Yes
No
Foreign Owned/Controlled:
Yes
No
Government Owned/Controlled:
Yes
No
Add
Add
10. ITAR Written Policies
Does the applicant have written policies and procedures for compliance with the ITAR (including but not limited to 22 CFR
122.5)?
Yes
No
11. Statement of Registration
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Under penalty according to federal law (22 U.S.C. 2278-2780; 22 CFR 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. I further warrant that:
In compliance with 22 CFR 122 with reference to 22 CFR 122.2(b)(1)(i) and (b)(1)(ii) and 22 CFR 129 with reference to 22
CFR 129.8(c)(1) (i) and c(1)(ii),
I hereby state that I am an authorized senior officer of the applicant and furthermore, I hereby certify that, with respect to the
applicant or its parent, subsidiary, or other affiliate listed herein, or any of its chief executive officers, presidents, vice
presidents, secretaries, partners, members, other senior officers or officials (e.g., comptroller, treasurer, general counsel), or
any member of the board of directors of the applicant, or of any parent, subsidiary, or affiliate listed herein:
Indicted/Charged/Convicted Status
No person has been indicted or otherwise charged (e.g., charged by criminal information in lieu of indictment) for or
convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR 120.27 or violating a foreign criminal law
on exportation of defense articles where conviction of such law carries a minimum term of imprisonment of greater than
1 year.
One or more persons has been indicted or otherwise charged (e.g., charged by criminal information in lieu of
indictment) for or convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR 120.27 or violating a
foreign criminal law on exportation of defense articles where conviction of such law carries a minimum term of
imprisonment of greater than 1 year. A copy of the relevant documentation is attached.
Contract and License Eligibility
No person 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.
One or more persons 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. A
copy of the relevant documentation is attached.
Supporting Documentation
File Name: _____________________________
Browse
Browse
Document Type:
Organizational Chart
Applicant Organization Type “Other” Explanation
Foreign Parent Designation
Indicted/Charged/Convicted Status Documentation
Explanation of Applicant Control/Ownership
Contract and License Eligibility Status Documentation
IRS Nonprofit Authorization
Proof Applicant is Currently Authorized to do Business
Documentation of Individual U.S. Person Status
Subsidiary/Affiliate Add/Remove Type “Other” Explanation
One Time Exemption Certification Letter
License Application for One Time Exemption
Broker Activity Report
Other Supporting Documentation
Upload
Senior Officer Application and Certification Signature
First Name:
________________________________________________________________________
Middle Name:
__________________________________________________________
Last Name:
________________________________________________________________________
Signature:
________________________________________________________________________
Date:
________________________________________________________________________
None
If Registration Action is “New”
Designate a Corporate Administrator
First Name:
DS-2032 v5.2
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________________________________________________________________________
Page 8 of 9
Last Name:
________________________________________________________________________
Position/Title:
________________________________________________________________________
Telephone:
________________________________________________________________________
Email:
________________________________________________________________________
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), 22 CFR Part 122, and Executive Order 13637. The authorities to register brokers are 22 U.S.C. 2778(b)(1)(A)(ii)(I), 22
CFR 129.3, and Executive Order 13637.
PURPOSE: The information gathered through registration is used to identify individuals and entities engaged in certain manufacturing, exporting and brokering activities.
The Department of State will use this information to build and maintain records of ownership, management and transactions related to munitions manufacture, export and
temporary import.
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. More information on the Routine Uses for the system can be found in the System of Records Notice
State-42, Munitions Control Records.
DISCLOSURE: Disclosure of this information is voluntary. Failure to provide the information requested will prevent completion of the registration process.
DS-2032 v5.2
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File Type | application/pdf |
File Title | Microsoft Word - DS-2032 Statement of Registration v5.2.docx |
File Modified | 2018-12-18 |
File Created | 2018-12-18 |