Dear Customer,

Thank you for choosing to purchase a FLIR Systems (“FLIR”) product. We are confident you will be satisfied for years to come.

In order to ensure compliance with trade restrictions to which FLIR and our products are subject, as a requirement for our sale to you we must collect certain specific information and/or documentation related tothe transaction, the intended end-user and the intended end-use of the product(s). This document is designed to assist youin providing this data to us. It will also allow us to determine what, if any, type of export authorization or export license maybe required. We ask that you complete this document thoroughly and return a signed copy to us.

For your information and assistance:

Company Names: Please provide the full legal name (including trading name) of the end-user / consignee / purchasing party / bank(s) and any additional thirdparties involved in the transaction. Third parties include any freight forwarders, import brokers, resellers, integrators, service support providers,or translation services providers, as applicable. Please define any acronyms used in these descriptions.

Addresses: Please provide the complete registered addresses for all parties. PO Box Numbers are not acceptable. When a street or roadname is not available please provide a description of the physical location; for example, provide a GPS location or physicaldescription of how to locate the facility to a visitor.

Additional information: When the FLIR product is being integrated or incorporated into another item (e.g., equipment, aircraft,vessel, vehicle, etc.) please provide a detailed description of the end-product or the associated equipment. Please also provide a productbrochure or data sheet if available.

Definitions: For the purposes of this document:

  • Military End-User includes but is not limited to the national armed services (army, navy, marine, air force, or coast guard), as well as the national guard and national police, government intelligence or reconnaissance organizations, or any person or entity whose actions or functions are intended to support military end-uses.With respect to Russia, this includes but is not limited to parties listed in Annex IV of Council Regulation (EU) No 833/2014 (as amended)[1].
  • Military End-Use means: incorporation into military items; for the use, development, production, or maintenance of military items, or for the use of production, test or analytical equipment and components therefor; use of any unfinished products in a plant for the production of military items; or for deployment in certain aircraft or aero gas turbine engines or related parts and components. [This includes specifically: incorporation into a military item described on theUK Strategic Export Control Lists or on the U.S. Munitions List (“USML”) in the U.S. International Traffic in Arms Regulations (22 C.F.R. Part 121); incorporation into a military item described on the Wassenaar Arrangement Munitions List (as set out on the Wassenaar Arrangement Web site at ); incorporation into items on the Commerce Control List in the U.S. Export Administration Regulations (15 C.F.R. Part 730 et seq.) (“EAR”) classified under Export Control Classification Numbers (“ECCNs”) ending in “A018” or under “600 series” ECCNs; for the “use,” “development,” or “production” of military items described on the USML or the Wassenaar Arrangement Munitions List, or items classified under ECCNs ending in “A018” or under “600 series” ECCNs on the Commerce Control List; or deployment of items classified under ECCN 9A991 as set forth in Supplement No. 2 to Part 744 of the EAR.]
  • Use includesoperation, installation (including on-site installation), maintenance (checking), repair, overhaul and/or refurbishing.
  • Development is related to all stages prior to serial production, such as: design, design research, design analyses, design concepts, assembly and testing of prototypes, pilot production schemes, design data, process of transforming design data into a product, configuration design, integration design, layouts.
  • Production means all production stages, such as: product engineering, manufacture, integration, assembly (mounting), inspection, testing, quality assurance.

Please contact your FLIR representative if you have any questions.

Thank you.

Global Trade Compliance Group

ELR Number: / ELR Number /
CER Number: / CER Number /

FLIR TRANSACTION INFORMATION SHEET (FLIRTIS)

RUSSIA TRANSACTIONS ONLY

Section 1 – CONTRACT INFORMATION
FLIR Department and Point of Contact / FLIR Dept and POC /
Name and Address of Purchasing Party / Name and Address /
Contact person within the purchasing company responsible for assisting with the export license procedure / Name:Name
Email address:Email
Telephone number:Telephone
Purchase Order/Contract Number / PO/Contract Number /
Date of Order / Date /
Product Description and Quantity / Product Description and Quantity /
Role in the Transaction (if more than just the purchasing entity) / Role in Transaction /
Details of ownership and control: direct and indirect beneficial owners (shareholder(s)) of Purchasing Party and respective shareholdings) and names of directors and officers of Purchasing Party
[If multiple shareholders, please provide copy of ownership structure] / Details of Ownership and Control /
Website / Website /
Commission(s) to be Paid (amount and to whom being paid) / Commission /
Payment Terms / ☐Payment in advance
☐Letter of credit (Please specify the name and address of the issuing, confirming and any intermediary banksfor the Letter of Credit in Section No. 5 below)
☐Net 30 days
☐Other
Section 2 - END-USER INFORMATION AND END-USE OF THE PRODUCT
End-User Name / End-User Name /
Full Address / Address /
Contact Person / Name:Name
Email address:Email
Telephone number:Telephone
Military End-User? (Refer to definition on first page) / ☐Yes ☐No
Military End-Use? (Refer to definition on first page) / ☐Yes ☐No
Will the product be used in Russia for exploration for, or production of, oil or gas in any of the following? / Deepwater projects (i.e., greater than 500 foot depth)
☐Yes ☐No
Offshore projects in the Arctic Ocean or above the Arctic Circle
☐Yes ☐No
Shale projects
☐Yes ☐No
Details of ownership and control: direct and indirect beneficial owners (shareholder(s)) of End-User and respective shareholdings) and names of directors and officers of End-User
[If multiple shareholders, please provide copy of ownership structure] / Details of Ownership and Control /
Website Address / Website /
Nature of Business (what does the company manufacture, or what service is being provided?) Provide as much information as possible. / Nature of Business /
Detailed description of the intended end-use of the product (how will the equipment be used?) Provide comprehensive description of intended end-use. / End-Use Description /
Integration/installation details- 1.) Provide specification and/or brochure of end-product; 2.) Provide details if product is being installed onto a platform such as a pole, rooftop, vessel, aircraft, or vehicle. / Integration/Installation Details /
Provide serial number and previous authorization (license number) if this is a re-export/transfer request. / Serial Number and Authorization /
Section 3 – CONSIGNEE (If different from the Purchasing Party/End-User, provide the contact details of the company that will receive the product)
Consignee Name / Name /
Full Address / Address /
Contact Person / Name:Name
Email address:Email
Telephone number:Telephone
Details of ownership and control: direct and indirect beneficial owners (shareholder(s)) of Consignee and respective shareholdings) and names of directors and officers of Consignee
[If multiple shareholders, please provide copy of ownership structure] / Details of Ownership and Control /
Website Address / Website /
Nature of Business (what does the company manufacture, or what service is being provided?) Provide as much information as possible. / Nature of Business /
Detailed description of the intended end-use of the product (how will the equipment be used?) Provide comprehensive description of intended end use. / End-Use Description /
Integration/installation details- 1.) Provide specification and/or brochure of end-product; 2.) Provide details if product is being installed onto a platform such as a pole, rooftop, vessel, aircraft, or vehicle / Integration/Installation Details /
Section 4 – ADDITIONAL PARTIES
Party No. 1
Company Name / Name /
Full Address / Address /
Contact Person / Name:Name
Email address:Email
Telephone number:Telephone
Website Address / Website /
Role of Party in Transaction / Role in Transaction /
Nature of Business (what does the company manufacture, or what service is being provided?) Provide as much information as possible. / Nature of Business /
Detailed description of the intended end use of the product (how will the equipment be used?) Provide comprehensive description of intended end-use. / End-Use Description /
Integration/installation details- 1.) Provide specification and/or brochure of end-product; 2.) Provide details if product is being installed onto a platform such as a pole, rooftop, vessel, aircraft, or vehicle / Integration/Installation Details /
Party No. 2
Company Name / Name /
Full Address / Address /
Contact Person / Name:Name
Email address:Email
Telephone number:Telephone
Website Address / Website /
Role of Party in Transaction / Role in Transaction /
Nature of Business (what does the company manufacture, or what service is being provided?) Provide as much information as possible. / Nature of Business /
Detailed description of the intended end-use of the product (how will the equipment be used?) Provide comprehensive description of intended end-use. / End-Use Description /
Integration/installation details- 1.) Provide specification and/or brochure of end-product; 2.) Provide details if product is being installed onto a platform such as a pole, rooftop, vessel, aircraft, or vehicle / Integration/Installation Details /
Party No. 3
Company Name / Name /
Full Address / Address /
Contact Person / Name:Name
Email address:Email
Telephone number:Telephone
Website Address / Website /
Role of Party in Transaction / Role in Transaction /
Nature of Business (what does the company manufacture, or what service is being provided?) Provide as much information as possible. / Nature of Business /
Detailed description of the intended end-use of the product (how will the equipment be used?) Provide comprehensive description of intended end-use. / End-Use Description /
Integration/installation details- 1.) Provide specification and/or brochure of end-product; 2.) Provide details if product is being installed onto a platform such as a pole, rooftop, vessel, aircraft, or vehicle / Integration/Installation Details /
Section 5 – BANKS
Provide names and full addresses of any banks or payment intermediaries that will be involved in the transaction / Bank Name and Address /
Describe role(s) of any banks or payment intermediaries (e.g. remitting bank, issuing/confirming/advising bank for letter of credit, etc.) / Role of Bank /
What currency will be used for payment? / Currency Used /
Section 6 – CERTIFICATION AND SIGNATURE
I certify that the information provided herein is true, complete and accurate to the best of my knowledge, and that:
1)The products acquired from FLIR will not be directly or indirectly exported, reexported, sold, rented, leased, transferred, diverted, or otherwise used or disposed of in violation of, or in any manner that would cause FLIR to be in breach of, any applicable sanctions and export controls, including those maintained by the United States, European Union and its Member States, Canada, or other countries.
2)The products will not be used in the design, development, production or use of nuclear, chemical or biological weapons or missiles.
3)The products are not destined or intended for (i) any military end-customer, (ii) any military end-use, or (iii) for the design, development, production or use of chemical, biological, or nuclear weapons or their precursors, or of missile technology or unmanned aerial vehicles, or for terrorist activities.
4)The products will not be supplied for use, directly or indirectly, in the exploration for or production of oil or gas in deepwater (greater than 500 feet), Arctic offshore, or shale projects in Russia.
5)Customer is not, and no parties involved in the transaction are, identified on any restricted party lists maintained by the United States, European Union and its Member States, or Canada. Such restricted party lists include but are not limited to the Specially Designated Nationals and Blocked Persons List (“SDN List”) and Sectoral Sanctions Identifications List (“SSI List”) maintained by the U.S. Office of Foreign Assets Control; the Entity List, Unverified List, and Denied Persons List maintained by the U.S. Bureau of Industry and Security; the EU/UK Designated Parties List, the EU/UK Investment Ban Targets List, and entities listed in Annex IV of Council Regulation (EU) No 833/2014 (as amended)[2]; and the Anti-terrorism Financing List maintained by the Canada Office of the Superintendent of Financial Institutions as well as the Canadian Special Economic Measures (Russia) Regulations, Freezing Assets of Corrupt Foreign Officials (Ukraine) Regulations, and Special Economic Measures (Ukraine) Regulations (collectively, “Canada Restricted Party Lists”).
6)Customer is not, and to the best of Customer’s knowledge no parties involved in the transaction are, owned or controlled by one or more parties identified on the SDN List, SSI List, EU/UK Designated Parties List, or Canada Restricted Party Lists.
7)The products are not intended for, will not be supplied to, and will not be part of any transaction involving the provision of goods, services or technology to Crimea, any person ordinarily resident in Crimea, or any entity in Crimea [and will not be sold, diverted, transferred or exported/reexported to any other sanctioned destination (currently: Cuba, Iran, North Korea, the Republic of Sudan, or Syria)].
Name: / Name /
Signature:
Title: / Title /
Company Name: / Company /
Date: / Date /

Document 4201570d

February 14, 2017

6759193-v6\SFODMS

[1]The Annex IV list current as of 11 July 2016 is available at the hyperlink provided above( However, the EU updates its restricted party lists regularly, and the latest version of Council Regulation (EU) No 833/2014 should be checked for any updatesprior to completing this certification at the following link:

[2]The Annex IV list current as of 11 July 2016 is available at the hyperlink provided above( However, the EU updates its restricted party lists regularly, and the latest version of Council Regulation (EU) No 833/2014 should be checked for any updatesprior to completing this certification at the following link: