& Hand Carry of Controlled Items
RC-ECF. 001 (Rev.5) This document is UNCONTROLLED in printed form Date printed: 2/1/2013
General Trip Information (to be completed by Traveler).
For instructions for completion of form, see Section 9.
1. Requestor Information
Requestor Name: Title: Request Date:
Phone: Email:I certify that I have satisfactorily completed all required export compliance training: No Yes
2. Destination
List all countries you are traveling to or transiting through:
Departure Date: Return Date:
What is the purpose for your travel?
3. Hand Carry Items / Not Sure / Yes / No
(If any items are to be carried, please complete and sign the attached Hand Carry Letter.)
a. Please check each item you are taking with you, either hand carried or stowed in your checked luggage:
Laptop computer iPhone Standard company-issued software on all items
Blackberry Cell phone Commercial encryption software
b. Will the item(s) or software return to the US within 12 months or be consumed or destroyed abroad?
c. Will any of the item(s) or software be taken into any of the following countries: Iran, Syria, Cuba, North Korea or Sudan?
d. Will the item(s) or software be used exclusively:
• As a "tool of the trade" to conduct ACADEMI Training Center or subsidiary company business?
• For exhibition or demonstration?
e. Will the item(s) or software be used for inspection, testing, calibration or repair?
f. If yes, will they be shipped, retransferred, or hand-carried to any of these countries: Albania, Armenia, Azerbaijan, Belarus, Cambodia, China, Georgia, Iraq, Kazakhstan, Kyrgyzstan, Laos, Libya, Macau, Moldova, Mongolia, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan or Vietnam?
g. Will the item(s) or software remain under the "effective control" of ACADEMI LLC and subsidiary personnel while the item(s) are abroad? Note: "Effective Control" is defined as retaining physical possession of an item or maintaining it in a secure environment such as a hotel safe or a locked or guarded facility.
4.
4. Nature of the Software and Data
(If the answer to both 4a and 4b is "Yes," skip to Section 6.) / Not Sure / Yes / No
a. I certify that the commodities I will be carrying contain no software or data restricted under export compliance regulations, e.g. technical data, curriculum, blueprints, etc.
b. If there is encryption code incorporated in the item or on the software media, is it limited to that available through retail purchase (phone order, mail, internet, or over-the-counter transactions)?
5. Technical Data
What are you taking with you? Check all that apply, and please be as specific as possible in your descriptions. If you are not sure how to complete this section, leave it blank and your Export Compliance Officer will help you:N/A Yes
Technical Data (Commerce): Examples include but are not limited to: specific information necessary for the development, production or use of EAR-controlled items. May take forms such as blueprints, plans, diagrams, models, formulae, tables, engineering design and specifications, manuals and instructions in written form or recorded or other media such as disk, tape, thumb drives, etc.
Describe:
Technical Data (State): Examples include but are not limited to: any information which is required for the design, development, production, manufacture, assembly, operation, repair, testing, maintenance or modification of defense articles such as information, whether in hard copy or electronic format, in the form of blueprints, drawings, photographs, plans, instructions, and documentation; classified information relating to defense articles and defense services, e.g. tactics, techniques, and procedures; information covered by an invention secrecy order; and software including but not limited the system functional design, logic flow, algorithms, application programs, operating systems and support software for design, implementation, test operation, diagnostic and repair.
Describe:
6. Certification of Understanding
I certify that I have read, understood, and will comply with all these instructions. I further affirm that all information provided is complete and accurate to the best of my knowledge.Signature:
For Completion by Export Compliance
7.8.
7. Export Authorization Required
No Yes An EAR authorization is required.No Yes An ITAR authorization is required.
No Yes EAR Exception applicable.
No Yes ITAR Exemption applicable.
No Yes No License Required (Insert applicable ECCN or EAR99):
8.
8. EC Officer Confirmation of Compliance
a.
b.
c.
Comments:
EC Officer signature: ______
EC Officer Name: Date:
9. Instructions for completion of form
a) Complete this form prior to international travel.b) Submit form to Export Compliance Helpdesk at: and copy Export Compliance Officers
c) If you intend to meet with foreign nationals or representatives of foreign interests, complete Form RC-ECF002: Request for Approval or Notification of Meeting with Foreign National Participants and send it to the ECHelpdesk with this form.
d) Await Export Compliance Confirmation of Compliance prior to exporting any assests.
e) If any deviations or changes to your itinerary occur during the execution of international travel, please notify Export Compliance upon return.
ITAR-controlled Technical Data
Technical Data as defined by the International Traffic in Arms Regulations (ITAR) at ITAR 120.10 must not be on your laptop computer or device without a valid written export authorization.
Frequent international travel
This form is valid for one year and does not need to be renewed for each international trip you take. However, if technical data is exported on a laptop, Blackberry or device then Section 3: Technical Data must be completed for each international trip in which technical data will be taken.
Encryption softwareBe aware that certain countries prohibit entry of even commercial encryption software into that country – you should check to see if your travel includes one of these countries.
VPN Software
There may be special issues concerning VPN software for countries such as Russia, China, etc. Some countries do not allow VPN software to be imported into the country. Check with the individual country’s embassy to determine VPN restrictions. Arrest or detention my host country can occur for violation of their import/export laws.
Valuation for Hand Carry Letter
· An estimated value for Customs purposes, the standard ACADEMI LLC laptop computer and associated software is valued at approximately $1,500.00, the standard PDA cost is approximately $1,000.00 and a Blackberry or iPhone is $500.00.
Keep these documents with you
Keep these documents with your computer, Blackberry or iPhone during the course of your international travel through US Customs.
Page 5 of 6
RC- ECF. 001 (Rev.5) This document is UNCONTROLLED in printed form Date printed: 2/1/2013
TO WHOM IT MAY CONCERN:
Subject: Temporary Export of Commodities from the United States
I, , hereby certify that the following commodities listed below as in my possession are the property of ACADEMI LLC and its’ subsidiaries, and are being temporarily exported from the United States in full accordance with the Export Administration Regulations (15 CFR 730-774) and the International Traffic in Arms Regulations (22 CFR 120-130). These commodities:
· Are for my personal use and will remain under my constant control;
· Are for temporary export and subsequent re-import only, and are not for resale;
· Will be returned to the U.S. within twelve (12) months of initial departure date;
· Are deemed to be “tools of the trade” used in the ordinary course of the company’s business;
· Qualify as either No License Required (NLR) Temporary Export or Temporary Import (TMP) License Exception (15 CFR 740.9);
· An Electronic Export Information (EEI) or Automated Export System (AES) filing is not required pursuant to FTR § 30.37(b);.
· VPN access is authorized under license exception (BAG)
· All software loaded represents commercially available software exportable under Department of Commerce exception Technology and Software Unrestricted (TSU)
Kind of item (e.g. Blackberry, computer, software, etc)Manufacturer:
Model Number:
Serial Number:
ACADEMI LLC Asset Number:
Estimated Value:
Kind of item (e.g. Blackberry, computer, software, etc)
Manufacturer:
Model Number:
Serial Number:
ACADEMI LLC Asset Number:
Estimated Value:
Kind of item (e.g. Blackberry, computer, software, etc)
Manufacturer:
Model Number:
Serial Number:
ACADEMI LLC Asset Number:
Estimated Value:
Kind of item (e.g. Blackberry, computer, software, etc)
Manufacturer:
Model Number:
Serial Number:
ACADEMI LLC Asset Number:
Estimated Value:
Traveler's Signature: ______
Traveler's Name:
Export Compliance Officer Signature: ______
Name:
Export Compliance Officer
ACADEMI LLC
Page 5 of 6