Malaysia End User Statement FLEXJABILv4 - cisco.com

1 PLEASE NOTE THIS FORM MUST BE PRINTED ON COMPANY LETTER HEAD PAPER Rev 4 Page 1 FORM 5 (Paragraphs 10(7)(b), 11(5)(b), 12(7)(b), 13(4)(b) and 14(1)) END USE Statement For presentation in compliance with Strategic Trade Act 2010 (Act 708) Malaysia We, Certify that we have requested below supplier(s) to supply us the following strategic/unlisted* items: JABIL CIRCUIT SDN,BHD, PLOT 56, HILIR SUNGAI KELUANG 1, BAYAN LEPAS INDUSTRIAL PARK, PHASE 4, 11900 BAYLAN LEPAS, PULAU PINANG; and FLEXTRONICS TECHNOLOGY (PENANG) SDN,BHD, PLOT 13 , PHASE 4, PRAI INDUSTRIAL ESTATE, 13600 PRAI, PULAU PINANG Description of the items: TELECOMMUNICATION EQUIPMENT and SOFTWARE Category codes: 5A002 and 5D002 ECCN are cisco items as listed on the Multi-Use permit numbers MITI/STS/(S)/10-25 and MITI/STS/(S)/10-23 Quantity and Value: (mandatory for Single-Use Permit): Supplier ECCN QUANTITY VALUE JABIL 5A002 50,000 pieces $500,000, JABIL 5D002 50,000 pieces $500,000, FLEXTRONICS 5A002 50,000 pieces $500,000, FLEXTRONICS 5D002 50,000 pieces $500,000, which is intended for (please tick whichever applicable).

2 Consumption in _____ for _____ (country of final destination) (details of end-use OR industry/business activity involved) Production in _____ for _____ (country of final destination) (details of end-use OR industry/business activity involved) Distribution in _____ for ___Telecommunications_____ (country of final destination) (details of end-use OR industry/business activity involved) Repair in _____ for _____ (country of final destination) (details of end-use OR industry/business activity involved) Others in _____ for _____ (country of final destination) (details of end-use OR industry/business activity involved) x PLEASE NOTE THIS FORM MUST BE PRINTED ON COMPANY LETTER HEAD PAPER Rev 4 Page 2 FORM 5 (Paragraphs 10(7)(b), 11(5)(b), 12(7)(b), 13(4)(b) and 14(1)) END USE Statement We (I) certify that the Strategic Items/Unlisted Items will not be used for any restricted activity that supports the development, production, handling, usage, maintenance, storage, inventory or proliferation of any weapons of mass destruction and its delivery system or participation in transaction with persons engaged in such activities.

3 We (I) also certify that we will not subsequently export or otherwise re-sell the items to any person or country that is subject to any sanction imposed pursuant to a decision of the United Nations Security Council. If you have a Company Stamp please affix the stamp here: or If you do not have a Company Stamp check the box below: We declare we have no Company Stamp. Please sign below and complete the required information: Date:_____ _____ Original signature of Ship To or End User or government official _____ Enter Signer s Name in BLOCK LETTERS _____ Enter Signer s Title in BLOCK LETTERS _____ Enter Signer s email address in BLOCK LETTERS _____ Enter Signer s web page in BLOCK LETTERS _____ Enter Signer s Phone Number _____ Enter Signer s FAX number PLEASE NOTE THIS FORM MUST BE PRINTED ON COMPANY LETTER HEAD PAPER Rev 4 Page 3 Declaration Regarding Difference in Address between the Ship to Location Address and the Letterhead Paper/ and or Declaration Regarding Website Address We, declare that the reason the ship to address and the letter does not match or why the web address does not match is _____ _____ Date Original signature of the end user/government official