SUPPLIER IDENTITY SHEET

You (“Company”) are requested (i) to fill the present Identity Sheet as completely and accurately as possible, (ii) to update the information as often as necessary and, (iii) to mail all requested documents to Gemalto’s requester whose coordinates are mentioned in the side-letter.

I – Questionnaire Form:

1- Company General Information

What is the Company name?*:

What is the form (LLC…) of the Company?*

What is Your postal / registered address?*:

What is Your website address?

Who are the key contacts / phone numbers / e-mail addresses in the Company?

first name / last name / entity / postal address / e-mail address / direct phone number
C.E.O.
C.F.O.
E.V.P. Sales
Sales Manager
Key Account Manager

Supplier Identity Sheet_02.0.doc 5/7

Fields followed by a “*” must obligatorily be filled.

The present questionnaire contains confidential information and cannot be disclosed to a third party without the prior written consent of Gemalto and the Supplier.

SUPPLIER IDENTITY SHEET

Are You quoted on the stock exchange? Y ¨ / N ¨

If yes, what is Your identification number?:

What is Your Commercial Register Number?:

What are your main capital links?

shareholders
name / %
parent companies
name / mother company, subsidiary

What is(are) Your field(s) of activity(ies)?

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What products / services do You supply?

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Do You subcontract activity(ies)? Y ¨ / N ¨. If yes, please specify (R&D, manufacturing, deliveries, maintenance…)

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Please summarize Your history over the last 12 months:

What is Your foundation date?*

Have You acquired companies? Y ¨ / N ¨. If yes, please list them below

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Have You merged with other companies? Y ¨ / N ¨. If yes, please list them below

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Have You sold activities? Y ¨ / N ¨. If yes, please list them below

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Have You opened new plants? Y ¨ / N ¨. If yes, please list them below

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Have You closed plants? Y ¨ / N ¨. If yes, please list them below

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Have You faced at financial events? Y ¨ / N ¨. If yes, please list them below

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Have You been / are You in business relationship with Gemalto worldwide? Y ¨ / N ¨. If yes,

What is the date of entry into business relationship?

Which entities are You dealing with?

-

-

What products / services do You supply?

-

-

What is Your percentage of business with Gemalto?

2 - Financial statement

Figures in the table below are in k€ ¨ / k$ ¨

Company level
year n / year (n-1) / year (n-2)
revenue
gross profit
EBIT
profit (loss)
B.U. level
year n / year (n-1) / year (n-2)
revenue
gross profit
EBIT
profit (loss)
3 - Human Resources
year n / year (n-1)
Company
entity
4 - Strategy

What is your current strategy and what is your business plan for the next 3 years?

5- Production, Manufacturing, Services & Quality, Logistics

Facilities:

location / products / services

Have You faced at events (shortage of raw materials, Information Technology breakdown, strikes, Force Majeure events,…) having caused a stoppage of your production / shipments for more than 1 week over the past 12 months. Y ¨ / N ¨. If yes, please list them

6 – Corporate Social Responsibility (CSR)

Do You have a CSR board or equivalent? Y ¨ / N ¨. If yes, please identify the key interfaces below.

-

Do you have a corporate CSR policy? Y ¨ / N ¨. (provide a copy)

-

Do you have an environmental policy? Y ¨ / N ¨. (provide a copy)

-

Do you have an Internal social policy? Y ¨ / N ¨. (provide a copy)

-

Have you adhered to the Un Global Compact? Y ¨ (date of the signature)/ N ¨

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Have you been scored in terms of CSR by the company Ecovadis or others?

If Yes: Thanks to provide a copy of the report with the scoring

Do you have a documented business continuity plan for the activity concerning Gemalto?

Y ¨ (Please provide a copy)/ N ¨

Is your company certified ISO 14001 – 26000 – OHSAS 18001? (if yes thanks to provide a copy of your certificate)
7 – Suppliers

Have you a Supplier Selection Process? Y ¨ / N ¨. (Please describe)

Are environmental and social criteria taken into account in Your Supplier Selection Process? Y ¨ / N ¨. (Please comment)

How do you assess suppliers’ performances? (Please describe)

8 – Customers

Who are your main current customers?

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-

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How many customers each represents more than 10% of Your revenue?

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-

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What is Your percentage of business with Gemalto competitors?

9 – Comments

(Please provide any information you consider relevant for Gemalto)

II - Documents to be enclosed:

¨Annual report / balance sheet

¨Organization Flow Chart

¨Quality Assurance Manual

¨Corporate Social Responsibility policy / charter

¨Photocopies of Certifications (quality, security) per site and organization

Questionnaire filled by [name, title] on [date]

Signature

Supplier Identity Sheet_02.0.doc 5/7

Fields followed by a “*” must obligatorily be filled.

The present questionnaire contains confidential information and cannot be disclosed to a third party without the prior written consent of Gemalto and the Supplier.