Ukraine’s Request for Refurbishment or Repair Services

To: [DSCA Program Manager]

[Elements that must be included]:

1. On behalf of the Government of Ukraine, I respectfully request the below described Ukraine Security Assistance Initiative (USAI) refurbishment and/or repair services for defense articles owned by the Government of Ukraine. [add information as applicable]
   1. [Description of the defense articles (or categories if blanket in nature) and type of refurbishment and/or repair that is necessary].
   2. [Transportation requirements if applicable].
   3. [Describe status and location of the defense articles.]
2. The Government of Ukraine agrees to hold the U.S. Government harmless for any loss or damage to the above-described Government of Ukraine titled property and indemnify the U.S. Government from any third-party claims which result from Ukraine’s use of any returned defense articles.
3. The Government of Ukraine acknowledges and agrees that in the event that the U.S. Government cannot refurbish or repair some or all of the above-described Government of Ukraine’s titled defense articles (either the defense articles are beyond economic repair, grant funds have been expended without a new source, or Ukraine’s program has been suspended or cancelled), and the U.S. Government informs the Government of Ukraine’s representative who submitted this request of the need to regain physical custody of the provided Ukraine’s titled defense articles located at a specific location by a certain date, the Government of Ukraine acknowledges and agrees that that Ukraine may be solely financially responsible for funding any necessary transportation costs to ship Ukraine’s defense articles from that specific location to Ukraine’s representative. The Government of Ukraine also acknowledges and agrees that if Ukraine fails to regain physical custody of their titled property by the U.S. Government specified return date, that the Government of Ukraine may also be solely financially responsible for any resulting storage costs that accrue after the U.S. Government specified return date.
4. The Government of Ukraine acknowledges that any U.S. Government expenditure of USAI funds to attempt or accomplish the requested refurbishment and/or repair services qualifies as provided military assistance for the purpose of the Agreement between the Government of the United States of America and the Government of Ukraine on the Establishment of a United States-Ukraine Reconstruction Investment Fund, dated May 23, 2025.

Ukrainian Signature Block:

Requesting Authority Signature Block:

United States European Command (USEUCOM) Representative Endorsement:

On behalf of USEUCOM, I confirm that the USEUCOM will be responsible for accomplishing any applicable planning and requirements definition for the above Ukrainian requested BPC support.