Dd Form 2345 – Fill Out and Use This PDF

1. TYPE OF SUBMISSION (X one) a. INITIAL b. REVISION c. RENEWAL

Mark only one box: INITIAL if this is your first application; REVISION (of a previously accepted submission) showing revised information i.e., new addresses or business description; RENEWAL if your certification is nearing the expiration date or was canceled after expiration.

2. ENTITY OR INDIVIDUAL DATA a. NAME OF ENTITY OR SOLE PROPRIETOR (must match CAGE registry)

For an entity, show full name of CAGE or institution. For an individual, show full name (First, Middle Initial, Last). The information entered here must match the information in the CAGE registry.

Enter the physical address of the entity or individual making application. If a P.O. Box is used for mailing purposes, include street address as well.

c. NAME is for use by UNIVERSITY, COLLEGE, or HIGHER LEARNING INSTITUTION Only.

CAGE CODE is Mandatory.

3. DATA CUSTODIAN (Primary) 3.1. DATA CUSTODIAN (Alternate)

Show the name, business title, telephone number (including area code - direct line) and e-mail address of the individual(s) who will receive export controlled technical data / critical technology data and be responsible for its further dissemination.

Describe the relevant business activity of the entity in block 2 with sufficient detail for the U.S. or Canadian Government agency controlling the data to determine whether the militarily critical technical data that you may request over time is reasonably related to your stated business activity.

NOTE: The information must fit in the space provided in block 4 on the form. Attachments to block 4 are NOT ALLOWED.

For All Applicants you must specifically address the following in block 4: Indicate if you are a Prime or Sub-Contractor (If applicable).

If a Sub, include the Prime's CAGE and Address.

Describe what you do: (i.e.: manufacturer, distributor, data broker, consultant, other)

Describe what type(s) of equipment/material/service you manufacture. Provide commodity NAICS (North American Industry Classification System) or FSC (Federal Supply Class) if known.

Is your equipment/material/service related to the United States Munitions List (USML) or Commerce Control List (CCL)? If yes, state what category.

For U.S. Applicants: Are you registered with Directorate of Defense Trade Controls (DDTC)? If yes, state so and provide documentation.

For Canadian Applicants: Are you registered with the Controlled Goods Program? If yes, state so and provide Controlled Goods number (CG#####).

Do you possess an Export Control License? If yes, state so and provide documentation in your submission.

State your purpose for technical data access: (Bid on DoW solicitations, exchange of data, conference attendance, research, and development)

Do you require access to a system to obtain technical data? I do not require system access to systems OR I require access to SAM.gov, DIBBS (include User IDs)

Indicate the government agency or 3rd party requiring you obtain JCP Certification. Include full Point of Contact information.

The CITIZENSHIP/RESIDENCY STATUS of the individual(s) designated by name in Item 3 above, who will act as custodian(s) of the militarily critical technical data on behalf of the entity, is/are citizen(s) or person(s) admitted lawfully for permanent residence into (X) 1 or (X) 2

If the location of the entity identified in Item 2.a. is in the United States, the Data Custodian(s) must be a U.S. citizen, or a person admitted lawfully for permanent residence into the United States.

If the location of the entity is in Canada, the individual named in Item 3 may be either a Canadian or U.S. citizen or a person admitted lawfully for permanent residence into Canada.

Data Custodian(s)'s lawful residency must be in the entity's country of certification.

They are not themselves debarred, suspended or otherwise ineligible to perform on U.S. or Canadian Government contracts, and have not violated U.S. or contravened Canadian export control laws and have not had a certification revoked under the provisions of U.S. DoDD 5230.25 or Canada's TDCR.

No person employed by, or eligible persons designated by the certified entity to act on their behalf, who will have access to military critical technical data is disbarred, suspended, or otherwise ineligible to perform on U.S. or Canadian Government contracts or has violated U.S. or contravened Canadian export control laws or has had a certification revoked under the provisions of U.S. DoDD 5230.25 or Canada's TDCR.

If certifications of 5e. and 5f. cannot be made, provide in a separate document, a full description of any extenuating circumstances which may give sufficient reason to accept your certification.

a. NAME OF INDIVIDUAL (First, Middle Initial, Last) b. TITLE c. SIGNATURE d. DATE SIGNED

"I certify that the information and certifications made by the Data Custodian and myself are true, complete, and accurate to the best of my knowledge and belief and are made in good faith."

(For U.S. contractors see U.S. Code, Title 18, Section 1001 and for Canadian contractors see the Defense Production Act.)

Submit your completed DD Form 2345 as a "pdf" attachment to: JCP-ADMIN@DLA.MIL

7. CERTIFICATION ACTION (For JCPO Use Only) 8. DoW OFFICIAL (For JCPO Use Only) 9. CANADIAN OFFICIAL (For JCPO Use Only)

This certification number, along with a statement of intended military critical technical data use, must be included with each request for militarily critical technical data.

The acceptance is valid upon approval until the expiration date in 7c unless sooner revoked under the provisions of U.S. DoDD 5230.25 or Canada's TDCR.

b. CERTIFICATION NUMBER c. EXPIRATION DATE (YYYYMMDD): Date Certification will expire. If not renewed it will be canceled.

If at any time a certified contractor is unable to adhere to the conditions under which a certification was accepted, the contractor's certification is considered void, and the contractor will, either submit a revised certification or surrender all export controlled technical data/critical technology data obtained under this agreement, to the data controlling offices specified on the documents.

I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both.