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🇬🇧 Thank you for your interest in the Divalto group and its solutions.

So that we can respond quickly and in the most appropriate fashion, please complete the form below carefully.

🇫🇷 Merci de l’intérêt que vous portez au groupe Divalto et à ses solutions.

Afin que nous puissions vous répondre rapidement et de manière appropriée, merci de remplir attentivement le formulaire ci-dessous. Veuillez également formuler vos réponses en anglais.

Étape 1 sur 4

Name(Nécessaire)

Division(Nécessaire)

Adress(Nécessaire)

Website URL(Nécessaire)

Extrait de KBIS de moins de 3 mois(Nécessaire)

Taille max. des fichiers : 100 MB.

Download Adress Verification Form Final

Download End User Statement

Adress Verification Form Final signé(Nécessaire)

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End User Statement signé(Nécessaire)

Taille max. des fichiers : 100 MB.

1. Is there any knowledge of military use, or whether one of the involved parties is from military, paramilitary, police, intelligence or related administration, or is owned or controlled by them, or is active in both civil sector and to a significant extent in the military sector?(Nécessaire)

2. Is there any knowledge of nuclear use (e.g., in a nuclear power plant or a nuclear research facility)?(Nécessaire)

3. Is there knowledge about an end use of the delivery / technical assistance in connection with Biological or Chemical Weapons or rocket systems?(Nécessaire)

4. Is there knowledge about an end use of the delivery / technical assistance in connection with drones or unmanned aerial vehicles?(Nécessaire)

5. Is there knowledge of direct or indirect involvement in the transaction of: (i) The Countries Belarus, Cuba, Iran, North Korea, Libya, Russia, Sudan, Syria, (occupied) Ukraine or Venezuela.(Nécessaire)

6. Is there knowledge that any of the involved partners is designated on the “BIS Entity List” or the “BIS Denied Persons List” or the “OFAC SDN list” OR is affiliated with any party on those lists?(Nécessaire)

7. Is there knowledge of direct or indirect involvement in the transaction of (ii) Any Iran, Syria or Russia persons (entities or nationals Answer Yes. Also if there any indications / red flags that items may be intended for use in any of those countries in 5(i) or involving persons in (ii) e.g. the ownership structure of any of the involved parties is related to these countries or according to publicly available information any of the involved parties is active on these markets?(Nécessaire)

8. Are there any Export Control red flags in the transactions i.e. partner does not fit to the market, items ordered do not fit to the partner, inconsistent or unreasonable end use, partner is evasive or unwilling to provide information about end-use, diversion risk identified etc?(Nécessaire)

9. Is the transaction in some way associated with goods for communications monitoring (such as for example intrusion software / covert surveillance)?(Nécessaire)

10. Is the transaction related in any way to the development or production of integrated circuits in an ‘advanced semiconductor fabrication facility’ in Mainland China, Hong Kong, Macau, or any U.S. country group D:5 (U.S. Arms Embargoed Countries) or by companies headquartered in those countries OR – Is the transaction related to the design of an advanced-node integrated circuit that will be produced in Macau or a destination specified in Country Group D:5, including China and Hong Kong?(Nécessaire)

11. Is the transaction for the purpose of provision, development or production of manufacturing, design, or testing equipment (hardware) for semiconductors, related materials, or military electronics in Mainland China, Hong Kong, Macau, or any U.S. country group D5 (U.S. Arms Embargoed Countries) or by companies headquartered in those countries?(Nécessaire)

12. Is the transaction in any way related to a “supercomputer” located in or destined for Mainland China or Hong Kong (e.g., development, production of components, maintenance, overhaul, use)?(Nécessaire)

13. Do you have knowledge that the goods will be exported to a free zone or a free warehouse?(Nécessaire)

Divalto a besoin de ces coordonnées pour vous contacter au sujet de ses produits et services. Vous pouvez vous désabonner de ces communications à tout moment cf. notre Politique de confidentialité web. Vous pouvez également consulter notre politique de protection des données.