UN Security Council
2002

Name Select ONE Point of Entry into Iraq Address 0 Trebil O Al Waleed 0 Zakho OI Umm Qasr OJ Ar'ar Phone/Fax/E-mail 13. END USER entity (if different from receiving company / org.) 14. END USE Name: Provide details of intended end-use. Address: Phone/Fax/E-mail: (attach additional sheets if necessary) 15. METHOD OF PAYMENT 30 From the Iraq Account in accordance 3 By other arrangement: with SC resolution 986 (1995) Provide as much detail as possible In this case, please fill out PAGES 2 and J (in this case, disregard Pages 2 and 3) (Relevant documentation including contract(s) must be attached) 16. ADDITIONAL INFORMATION: (Attach additional sheet if necessary) PAGE 1 of 3 15 S/RES/1454 (2002) IF THIS NOTIFICATION OR REQUEST TO SHIP GOODS TO IRAQ IS TO BE PAID FROM THE IRAQ ACCOUNT IN ACCORDANCE WITH SC RESOLUTION 986 (1995) PLEASE FILL OUT THESE ADDITIONAL BOXES (see box 15 on Page 1) MISSION REFERENCE No. 17. IDENTICAL GOODS PREVIOUSLY SUBMITTED: Indicate whether or not you have previously submitted an application(s) for IDENTICAL goods. YES No UNABLE TO DETERMINE