31.1.2019 Official Journal of the European Union EN L 30/49 Explanatory notes to the form ‘Authorisation for the supply of brokering services related to goods that could be used for capital punishment or for torture (Regulation (EU) 2019/125 of the European Parliament and of the Council (1))’. This authorisation form shall be used to issue an authorisation for brokering services in accordance with Regulation (EU) 2019/125. The issuing authority is the authority defined in point (h) of Article 2 of Regulation (EU) 2019/125. It is an authority that is included in the list of competent authorities in Annex I to that Regulation. Box 1 Applying broker Please indicate the name and full address of the applying broker. Bro­ ker is defined in point (l) of Article 2 of Regulation (EU) 2019/125. Box 3 Authorisation No Please fill out the number and tick the appropriate box indicating whether the authorisation is an individual or global one (see points (p) and (q) of Article 2 of Regulation (EU) 2019/125 for the defini­ tions). Box 4 Expiry date Please state day (two digits), month (two digits) and year (four digits). The period of validity of an individual authorisation is from three months to twelve months and that of a global authorisation from one year to three years. When the period of validity comes to an end, an extension can be requested, if necessary. Box 5 Consignee Please indicate, in addition to the name and address, whether the consignee in the third country of destination is an end-user, a distrib­ utor as referred to in point (r) of Article 2 of Regulation (EU) 2019/125 or a party having another role in the transaction. If the consignee is a distributor but also uses part of the shipment for a specific end-use, please tick both ‘Distributor’ and ‘End-user’ and mention the end-use in box 11. Box 6 Third country where the goods Please state both the name of the country concerned and the relevant are located country code taken from the codes established pursuant to Regu­ lation (EC) No 471/2009 of the European Parliament and of the Council (2). See Commission Regulation (EU) No 1106/2012 (3). Box 7 Third country of destination Please state both the name of the country concerned and the relevant country code taken from the codes established pursuant to Regu­ lation (EC) No 471/2009. See Regulation (EU) No 1106/2012. Box 9 Issuing Member State Please state in the appropriate line both the name of the Member State concerned and the relevant country code taken from the codes established pursuant to Regulation (EC) No 471/2009. See Regu­ lation (EU) No 1106/2012. Box 11 End use Please give a precise description of the use that will be made of the goods and also indicate whether the end user is a law enforcement authority as defined in point (c) of Article 2 of Regulation (EU) 2019/125 or a supplier of training on the use of the brokered goods. Leave blank if the brokering services are supplied to a distributor, un­ less the distributor itself uses part of the goods for a specific end-use. (1) Regulation (EU) 2019/125 of the European Parliament and of the Council of 16 January 2019 concerning trade in certain goods which could be used for capital punishment, torture or other cruel, inhuman or degrading treatment or punishment (OJ L 30, 31.1.2019, p. 1). (2) Regulation (EC) No 471/2009 of the European Parliament and of the Council of 6 May 2009 on Community statistics relating to external trade with non-member countries and repealing Council Regulation (EC) No 1172/95 (OJ L 152, 16.6.2009, p. 23). (3) Commission Regulation (EU) No 1106/2012 of 27 November 2012 implementing Regulation (EC) No 471/2009 of the European Parliament and of the Council on Community statistics relating to external trade with non-member countries, as regards the update of the nomenclature of countries of countries and territories (OJ L 328, 28.11.2012, p. 7).