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Web-DESI Certification Letter for
Electronic Declaration or Report Request

 Name of Facility, Plant Site or Trading Company 
 USC Code Number 

 The applicant company   (“Company”) hereby requests authorization for the above named facility, plant site or trading company to view/submit CWC declarations and reports using the Internet. The Company understands that an electronic submission has the same legal force and effect as a written submission. The Company recognizes that in order to view/submit CWC declarations and reports, the Company must be subject to the jurisdiction of the United States. The Company further understands that each individual authorized to submit declarations and reports via the Internet on behalf of the Company will be assigned an account for his or her exclusive use. The Company also understands that a password (USC password) will be assigned to Company for use with the US Code number assigned to our facility, plant site or company for use by all persons authorized to submit electronically for the Company. On behalf of the Company, I have read and understand Section 711.7 of the Chemical Weapons Convention Regulations (CWCR).

The Company agrees that each submission made via the Internet shall constitute a certification that:

  1. To the best of its knowledge and belief, all information submitted is in accordance with this procedure are true and complete;
  2. Submissions will conform to the instructions on accompanying printed declarations and reports and the CWCR;
  3. The Company will retain records pertaining to these CWC declarations or reports and make such records available as required by Part 721 of the CWCR;
  4. The Company will report promptly to the Treaty Compliance Division, Bureau of Industry and Security (TCD/BIS) whenever an account holder ceases to be employed by the Company or otherwise ceases to be authorized by the Company to submit declarations or reports via the Internet on its behalf.

The Company hereby certifies that the individuals listed below are authorized by the Company to act for the Company to view or submit declarations and reports via the Internet.

Company Name: ________________________________________________
Mailing Address: ________________________________________________
Facility, Plant Site or Trading Company Name: ________________________________________________
USC Code: ________________________________________________
Facility, Plant Site or Trading Company Address: ________________________________________________
Telephone Number: ________________________________________________
Facsimile Number: ________________________________________________

Corporate Officer's Certification:  

I am the owner, operator or senior management official of the Company and have the power to bind the Company herein.

Signature _____________________________________________

Print/Type Name and Title _______________________________

Telephone Number_________________________________________

Account Holder Certification:

I certify that:

  1. I have read and understand Part 711.7 of the CWCR;
  2. I have read this submission in its entirety;
  3. I understand how my account will be communicated to me;
  4. I understand my duties to safeguard my account;
  5. I understand that I may be personally liable for false statements contained in a submission made via the Internet; and
  6. I understand that each Internet submission I make shall constitute my certification and the certification of the applicant company as described above.

Employee Name Title Authorized Privileges* Telephone Number Email Address Signature and Date
*Authorized privileges are: View, Edit, or Edit/Submit