BLOCK 1
Application/License for Permanent/Temporary Export or Temporary Import of Classified Defense Articles and Classified Technical Data
Transaction Number
Enter your internal submission company identifier for this application.
Classified Information must NOT be included, or referred to, in the form.
Classified information must be sent separately to PM/DDTC in accordance with Defense Security Service guidelines. For issues that may pertain to classified information, contact the DDTC Response Team.
Classified
information is being sent under separate cover
Select this
field if you are going to send classified information that is
pertinent to the application under separate cover to the DDTC in
accordance with the Defense Security Service guidelines.
BLOCK 2
PM/DDTC Applicant/Registrant Code
Select your registration code. If no codes are displayed, confirm you have an active registration code prior to submitting a license application.
Registration Code
Select your registration code for this application.
BLOCK 3
Application Type
Application Type
Permanent Export
Temporary Export
Temporary Import
BLOCK 4
Country of Ultimate Destination or Temporary Sojourn
Enter the country or countries of ultimate destination or temporary sojourn. All countries of ultimate destination must be listed and must match the countries listed in Block 17. If the application relates to an agreement, the country of ultimate destination should be the country where the foreign licensee/s are located.
Destination Country (drop down menu)
BLOCK
5
Country from which Shipped
Available Countries (drop down menu)
Applicant’s Name, Address, Zip Code, Telephone Number
Check appropriate block to identify applicant. The first line MUST reflect name under which the applicant is registered. Subsequent lines may identify a specific subsidiary of the parent company. If subsidiary company is listed, list the subsidiary’s FSC. FSC Code, Level and Date of Clearance MUST be entered unless a foreign government.
Applicant Is
Select the applicant's business type. Select either Freight Forwarder, Government, or Manufacturer/Exporter.
Freight Forwarder
Government
Manufacturer/Exporter
Subsidiary
Select
if the applicant/requester is a subsidiary of the PM/DDTC registered
company to which the PM/DDTC registration code belongs.
Attention
Enter the first and last name of the person who is responsible for this application for the applicant.
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
State
Zip Code
Telephone
Extension
FSC Code
Clearance Level
Date of Clearance
Names, agency and telephone number of U.S. Government personnel (not PM/DDTC) familiar with the commodity. If Foreign Government Information (FGI) being exported, identify Country in “Other”
Check the appropriate block to identify the government agency responsible for the classification of the hardware or technical data. Include the name and telephone number of the program manager or other responsible official at the government agency. Use ‘Other’ only when referring to Foreign Government Information (FGI). To enter one or more U.S. Government personnel, click the "Add Entry" button.
U.S. Government Personnel
Name
The individual identified in this block must be an employee of the U.S. Government. Do not list an employee of the Directorate of Defense Trade Controls.
Telephone
Extension
Agency
Name and Telephone Number of Applicant Contact if U.S. Government needs additional information
Identify an individual of the applicant who is familiar with this application. This individual must know the security arrangements associated with the export or import of the classified hardware or technical data. To enter one or more applicant contacts, click the "Add Entry" button.
Applicant Contact
Name
Telephone
Extension
BLOCK 9
Check the appropriate block(s) in section a, b, and c. In all cases, include precedent Technical Assistant Agreement and/or Manufacturing License Agreement numbers where appropriate. Submit copies of referenced licenses or agreements and proviso letters.
A. This application represents
ONLY a completely new shipment
ONLY the unshipped balance of license number
B. The IDENTICAL commodity
Provide any related license numbers that apply to the sections below. If there are no related license numbers, select ‘was never licensed for this applicant.
Was licensed to the country in block 4 under license number.
Was licensed to other countries under license numbers.
Was returned without action under voided license numbers.
Was denied to the country in block 4 under voided license number.
Was never licensed for this applicant.
C. If the commodity is being financed under
Foreign Military Sale (FMS)
Foreign Military Financing (FMF)
Grant Aid Program
D. This application is related to a disclosure filed with Defense Trade Controls Compliance
Yes
No
BLOCK 10-15
Provide all required commodity information. At least one commodity must be identified. To enter one or more commodities, click the "Add Commodity" button.
- Commodity
Quantity Information
Quantity
Specify quantity of items to be shipped and select from the drop-down box the “Unit type” associated with the commodity. “Lots” can be used only for minor components or parts and technical data, but an itemized description must be entered in block 11, Commodity Description, and relevant documentation provided. Each commodity MUST be entered separately by selecting the “Add Commodity” button. If four different commodities are listed on the purchase order, four separate blocks must be prepared by the applicant, one for each item on the purchase order.
Unit Type (drop down menu)
Commodity Description
Commodity
Enter a brief description of the commodity, then select “Defense Article Type," as applicable. List each commodity, giving type, model number, catalog or part number. May select only one as Defense Article Types cannot be mixed since each commodity requires a separate entry.
Defense
Article Type
Technical Data
Hardware
Classification Level
Enter a classification for the commodity as follows: TS for Top Secret, S for Secret, C for Confidential, U for Unclassified, or R for Restricted. Note that Restricted is only used by foreign governments. If foreign government information (FGI) is being exported, enter the classification and the originating country, followed by the letters “FGI”. FGI country information must also be included and reflect the same country as the entry in Block 7.
USML Category
USML Category
USML Category and Subcategory MUST both be listed. Since the categories reflect the commodity in block 11, the USML Category must reflect that entry. For example, if IV technical data for IV(a), by selecting the USML and corresponding subcategory, the commodity would be specifically identified as technical data for a specific defense article.
USML Sub-Category
Value
Value for hardware should include the selling price for each item without supplementary costs such as packaging and freight. Value for technical data may be identified as reproduction and/or processing costs. The price MUST be per individual item and cannot be a combined or lump sum. The automated addition features on the form will add the subtotal and total.
Unit Price
Line-Item Total
This field is auto calculated based on Quantity and Unit Price.
Total Value
This field is auto calculated based on the sum of all Line-Item Totals.
BLOCK 16
Name and Address of Source of Commodity
Enter the name and address of the source. FSC information MUST be entered for each party. To enter one or more sources, click the "Add Entry" button.
Same as Block 6 (Applicant)
Select "Same as Block 6" if the Source is the same as the Applicant. When the "same as block 6" checkbox is selected, any data entered will be removed and updated with the information provided from the same as block.
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
FSC Code
Level
BLOCK 17
Name and Address of Manufacturer of Commodity
Enter the name and address of the manufacturer. FSC information MUST be entered for each party. To enter one or more manufacturers, click the "Add Entry" button.
Same as Block 6 (Applicant)
Select "Same as Block 6" if the Manufacturer is the same as the Applicant. When the "same as block" checkbox is selected, any data entered will be removed and updated with the information provided from the same as block.
Same as Block 16 (Source)
If the seller is the manufacturer of commodity(ies) or the same response as the manufacturer of commodity(ies), select the "Same as Block 16" checkbox. Note that if the "Same as Block 16" check box is selected, this field and the "Add" button become inactive.
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
State
Zip Code
FSC Code
Level
Date of Clearance
BLOCK 18
Name and Address of Foreign End-User
The FSC requirement applies only to foreign end user(s) other than foreign governments. To enter one or more foreign end-users, click the "Add Entry" button.
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
FSC Code
Level
Name and Address of Seller in United States
To enter one or more sellers in the United States, click the "Add Entry" button.
Same as Block 6 (Applicant)
Select 'Same as Block 6' if the U.S. Seller is the same as the Applicant. When the 'same as block' checkbox is selected, any data entered will be removed and updated with the information provided from the same as block.
Same as Block 16 (Source)
If the seller is the source of commodity(ies) or the same response as the source of commodity(ies), select the "Same as Block 16" checkbox. Note that if the "Same as Block 16" check box is selected, this field and the "Add" button become inactive.
Same as Block 17 (Manufacturer)
If the seller is the manufacturer of commodity(ies) or the same response as the manufacturer of commodity(ies), select the "Same as Block 17" checkbox. Note that if the "Same as Block 17" check box is selected, this field and the "Add" button become inactive.
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
State
Zip Code
FSC Code
Level
Date of Clearance
BLOCK 20
Name and Address of Foreign Consignee
Identify the foreign consignee authorized by the foreign end-user to receive the shipment. If the foreign consignee is the same as the foreign end-user, enter the information in the block. To enter one or more foreign consignee, click the "Add Entry" button.
Same as Block 18 (Foreign End-User)
Select 'Same as Block 18' if the Foreign Consignee is the same as the Foreign End-User. When the 'same as block 18' checkbox is selected, any data entered will be removed and updated with the information provided from the same as block.
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
FSC Code
Level
Date of Clearance
BLOCK 21
Name and Address of Consignor and/or Freight Forwarder in United States
Enter the complete name and address of U.S. freight forwarder(s) or consignor(s). The date and level of security clearance for each facility MUST be listed. 22 CFR 126.13(b) requires that all parties to the export be identified. If this is a for a temporary import, the U.S. party taking control of the commodities must be identified in this block. To enter one or more consignors and/or freight forwarders in the United States, click the "Add Entry" button.
Same as Block 6 (Applicant)
Select 'Same as Block 6' if the Consignor is the same as the Applicant. When the 'same as block' checkbox is selected, any data entered will be removed and updated with the information provided from the same as block.
Same as Block 16 (Source)
If the Consignor is the source of commodity(ies) or the same response as the source of commodity(ies), select the "Same as Block 16" checkbox. Note that if the "Same as Block 16" check box is selected, this field and the "Add" button become inactive.
Same as Block 17 (Manufacturer)
If the Consignor is the manufacturer of commodity(ies) or the same response as the manufacturer of commodity(ies), select the "Same as Block 17" checkbox. Note that if the "Same as Block 17" check box is selected, this field and the "Add" button become inactive.
Same as Block 19 (Seller)
If the Consignor is same response as the Seller, select the "Same as Block 19" checkbox. Note that if the "Same as Block 19" check box is selected, this field and the "Add" button become inactive.
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
State
Zip Code
FSC Code
Level
Date of Clearance
BLOCK 22
Specific Purpose
Enter
the specific purpose and end use or end item for the commodity in
Block 11
(e.g., turbine blades for jet engine for (nomenclature)
aircraft) and if appropriate,
explain the roles of the parties
in the transaction.
BLOCK 23
Name and Address of Cognizant DSS Security Office
Provide the name and address of the DSS security office responsible for administering the government-to-government transfer at the location where the classified hardware or technical data is packaged for shipment. Foreign governments are not required to complete this block; however certain situations may require explanation which may be provided on an attachment and if that is the case, the foreign government should enter “See Attached Letter” or similar. To enter one or more cognizant DSS security office, click the "Add Entry" button.
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
State
Zip Code
BLOCK 24
Complete Address to which License should be Mailed
All information must be entered completely. Do not state “Same as Block XX” or other similar statements. The FSC information MUST be completed. “Hold for Pickup” box marked only if the license will be picked up.
Hold for Pickup
Name
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
Country
State
Zip Code
FSC Code
Level
Date of Clearance
BLOCK 25
Applicant’s Statement
I,_______, an empowered official (22 CFR 120.67) 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:
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:
the subject of an indictment for or has been convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR 120.6 since the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 (June 30, 1976); or
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;
To the best of the applicant's knowledge, no party to the export as defined in 22 CFR 120.68(a) has been convicted of violating any of the U.S. criminal statutes enumerated in 22 CFR 120.6 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
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, as described in 22 CFR 127.11 of the ITAR, is attached.
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 Section 127.11 of the ITAR.
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.
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.
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.
Compliance with 22 CFR 130
This transaction does not meet the requirements of 22 CFR 130.2.
This transaction meets the requirements of 22 CFR 130.2. The applicant or its vendors have not paid, nor offered, nor agreed to pay, in respect of any sale for which a license or approval is requested, political contributions, fees or commissions in amounts as specified in 22 CFR 130.9(a).
The applicant or its vendors have paid, or offered, or agreed to pay, in respect of any sale for which a license or approval is requested, political contributions, fees or commissions in amounts as specified in 22 CFR 130.9(a). Information required under 22 CFR 130.10 is attached.
I am not authorized by the applicant to certify the conditions of 22 CFR 130.9(a). Please see the attached letter for such certification.
Privacy Act Statement
AUTHORITIES: The information is sought pursuant to the Arms Export Control Act (22 U.S.C. 2751 et seq.), the International Traffic in Arms Regulations (22 CFR Parts 120-130) and Executive Order 13637.
PURPOSE: The principal purpose of this information collection is to allow the Directorate of Defense Trade Controls (DDTC) to process Applications/Licenses for Defense Articles or Services in accordance with the Arms Export Control Act and the International Traffic in Arms Regulations.
ROUTINE USES: The information collected may be made available to appropriate agencies for law enforcement or pursuant to a court order. They 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 required to obtain benefits. Failure to provide the information requested on this form may result in delays in considering an application or in an application not receiving full consideration.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Tyrrell, Ryan M |
| File Modified | 0000-00-00 |
| File Created | 2025-03-11 |