Form DSP-73 Application/License for Temporary Export of Unclassified

OMB APPROVAL NO. 1405-0023
EXPIRATION DATE: 04-30-2018
*ESTIMATED BURDEN: 1 HOUR

Electronic Form Version Number: 9.3

* 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/ISS/DIR) Washington, D.C. 20520

U.S. DEPARTMENT OF STATE
DIRECTORATE OF DEFENSE TRADE CONTROLS
APPLICATION/LICENSE FOR TEMPORARY EXPORT OF
UNCLASSIFIED DEFENSE ARTICLES
*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 application. Classified information must be sent
separately to PM/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.
Required Documents
DSP-73

Optional Documents
22 CFR § 126.13 Certification Letter
22 CFR § 127.11 Exception to Policy Letter
Firearms and Ammunitions Import Permit
Firearms and Ammunitions Letter of Explanation
Manufacturer Unknown Letter of Explanation
Other Amplifying Data (e.g. Briefing, Proposals)
Precedent (identical/similar) Cases
Product Brochures
Supplementary Explanation of Transaction (e.g. White Paper)
Technical Drawings, Schematics, or Blue Prints

DSP-73

Included Documents

DSP-73, Page 1

of

4

SEAL
Signature

DATE ISSUED

License is hereby granted to the applicant for the described commodity to depart from
the United States for temporary export and return to the United States. This license
may be revoked, suspended or amended by the Secretary of State without prior notice
whenever the Secretary deems such action advisable.

LICENSE VALID FOR

LICENSE NO.

MONTHS FROM ABOVE DATE

UNITED STATES OF AMERICA DEPARTMENT OF STATE

APPLICATION/LICENSE FOR TEMPORARY EXPORT OF
UNCLASSIFIED DEFENSE ARTICLES
*1. Date Prepared

*2. DDTC Registration Code

*3. Select One:

02/15/2018

*4. Specific countries
of sojourn

Single departure and return
Series of departures and returns

5. Applicant
*Applicant is:

Government

Manufacturer

Exporter

*6. Probable Port of
Exit from U.S.
*7. Probable Port of
Entry into U.S.

Subsidiary
*Name

*Attention

*8. Probable Date of First Exit from U.S.

mm/dd/yyyy

*9. Probable Date of Final Entry into U.S.

mm/dd/yyyy

10a. Applicant Contact for Additional Information

*Address

*Name
Ext

*Telephone #

*City

Add

*ZIP Code

*State

Ext

*Telephone #

10b. U.S. Government Personnel (not PM/DDTC) Familiar
with Commodity
Name
Ext

Telephone #
Agency

Add

*11. Description of Transaction
A. This application represents

ONLY a completely new shipment

ONLY renewal of previously issued license no.

B. This application has related license #
*C. This application is related to a disclosure filed with Defense Trade Controls

No

Yes

Enter Compliance Disclosure Number:

Item *12. Quantity

*13. Commodity

*14. USML Category

Category
Unit Type
1

*15. $ Value
Unit Price

Add

Sub

*16. Total Value

Line Item Total

$

DSP-73, Page 2

17. Manufacturer of Commodity
Same as Block 5

18. Foreign Intermediate Consignee

Unknown

None

*Name

*Name

*Address

*Address

*City

*City

State

ZIP Code

*Country
*Role

*Country
Add

Add

19. Source of Commodity
Same as Block 5

20. Temporary Foreign Consignee
Same as Block 17

None

*Name

*Name

*Address

*Address

*City

*City

State

ZIP Code

*Country
Add

*Country
Add

22. Temporary Foreign End-User

21. U.S. Consignor/Freight Forwarder

Same as Block 20

Same as Block 5

*Name

*Name
*Address
*Address
*City
*City
*State

*Country
*ZIP Code

Add

Add

*23. Specific Purpose
Request for Prior Approval (22 CFR § 126.8)

*24. Is the Article an Aircraft or Vessel?
Yes

No

Note: Blocks 25 - 29 are on another page and are only
displayed if there is a "Yes" response to Block 24.

of

4

DSP-73, Page 3

of

DSP-73
* 30. Applicant's statement
I,

,

an empowered official (22 CFR 120.25) or an official of a foreign government entity in the U.S., hereby apply for a license to complete the transaction
described above; warrant the truth of all statements made herein; and acknowledge, understand and will comply with the provisions of 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 CFR 120.27 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 22 CFR 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
a. 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.
b. 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, as described in 22 CFR 127.11 of the
ITAR, is attached.
c. 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. However that party has met the conditions imposed by the Directorate of
Defense Trade Controls in order to resume standard submission of applications, not requiring an exception to policy as described in
22 CFR 127.11 of the ITAR.
d. I am not authorized by the applicant to certify the conditions of 22 CFR 126.13. The applicant and all of the parties to the transaction can
meet in full the conditions of 22 CFR 126.13 as listed above. Please see the attached letter from an official that is authorized by the
applicant to certify to the conditions of 22 CFR 126.13.
e. I am not authorized by the applicant to certify the conditions of 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, as described in 22 CFR 127.11
of the ITAR, and a letter from an official that is authorized by the applicant to certify to the conditions of 22 CFR 126.13 are attached.
f. I am not 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. However that party has met the conditions imposed by the Directorate of Defense
Trade Controls in order to resume standard submission of applications, not requiring an exception to policy as described in 22 CFR 127.11
of the ITAR. Please see the attached letter from an official that is authorized by the applicant to certify to the conditions of 22 CFR 126.13.

Signature
Signature

31. License to be sent to:

[Block is inactive on electronic form.]
Name

Address
City
State
Telephone #

ZIP Code
Ext

4

DSP-73, Page 4

of

4

CONDITIONS OF ISSUANCE AND TEMPORARY EXPORT PROCEDURES
1. This license is issued under the conditions cited in 22 CFR 120-130, including conditions and limitations as applicable to the specific license authorization.
2. Approval of this license shall not be construed as implying U.S. Government approval or commitment to authorize future exports of any defense article on
the U.S. Munitions List (USML) or any U.S. Government commitment with regard to any proposed manufacturing license, technical assistance or
distribution agreement that may result from a license authorization.
3. The issuance of a license for the temporary export of hardware does not authorize the export of any technical data, unless authorized by an exemption.
4. The issuance of this license does not release the applicant, or anyone acting on its behalf, from complying with other requirements of U.S. law and
regulations.
5. This transaction may be subject to end-use monitoring by the United States Government.
6. No transfer of title is authorized to occur during the period of temporary export from the United States and access to the defense article by foreign persons
shall only be in accordance with and for the purpose identified on the license.
7. Licenses for the temporary export of an aircraft or vessel: The applicant when using this license agrees that during its sojourn abroad (1) the aircraft/vessel
will remain demilitarized or has only those capabilities that are subject of this license, (2) the applicant will maintain a valid U.S. certification or registry,
(3) the aircraft/vessel will not be used in military activites, and (4) it will be operated only by a United States licensed operator (except during
U.S. Government approved demonstrations). Also, during its sojourn abroad, the commander will not transport in the aircraft/vessel any defense articles
(e.g., arms, ammunitions or implements of war) as described in the U.S. Munitions List unless authorized in this license or by a separate license or
exemption under appropriate U.S. Government regulations.
8. The prior written approval of the Department of State, Directorate of Defense Trade Controls, must be obtained before USML articles exported from the
United States using a license or other approval, to include an ITAR exemption, may be resold, transferred, diverted, transshipped, reshipped, re-exported to,
or used in any country, or by any end user or for any end use, other than that described on the license or other approval.
9. The defense articles authorized for temporary export may be shipped only from a U.S. Port where a U.S. Customs and Border Protection officer is
available. It may not be shipped on any vessel, aircraft or other means of conveyance that is owned or operated by, or leased to or from, any of the
proscribed countries or areas. The applicant retains the original license. Prior to each export or entry the applicant presents the original license to a U.S.
Customs and Border Protection officer for verification and endorsement, having declared the export or entry in accordance with the ITAR and
U.S. Customs and Border Protection procedures using the Automated Export System (AES). When a license is authorized for the temporary export of an
aircraft and vessel, in addition to presenting the license for verification and endorsement, the exporter must carry the U.S. Customs and Border Protection
endorsed license on board as evidence of proper export authorization. Any article temporarily exported must be returned to the U.S. prior to expiration of
the license. Otherwise the applicant must request a renewal license at least 60 days prior to the expiration date to renew the authorization. In any instance
when a request for renewal is not granted the exporter must immediately return the articles to the U.S.

DISPOSITION OF LICENSE
The final disposition of this license shall be in accordance with 22 CFR 123.22(c).

ENDORSEMENT
Indicate below which COMMODITY is BEING EXPORTED and maintain a CONTINUING BALANCE of the remaining value:
SHIPMENT
DATE

QUANTITY

COMMODITY

SHIPMENT VALUE

XTN/ITN

INITIALS

PORT OF
EXIT/ENTRY

TOTAL AUTHORIZED VALUE:

REMAINING BALANCE:

NOTE Continuation of additional shipments must be authenticated by use of continuation sheets in the U.S.Customs handbook.