‘chevron FCPA Assessment Questions ‘The folowing 4 questions are forthe purpose of ensuring Chevron's compliance with a eievant Iegistion. Chevron requires completion ofthese 4 questions prot fo erring into a busness or employment relationship with an Indvidval Answering Yes" fo ony of these questions wil NOT ‘dsqualty you fiom consideration, however ii may lead fo adaiona! sreening ofthe potential _buness or employment celohonship for compfance and Chevion may need fo contact you for ‘defn irfonnaton regeralng the coment or former goverment assecation, 137 answering these questions. I consent fo the collection and use of the infrmation forthe upotes of ensuring compliance wih al relevant legilation and ocknowledge that I wil be fortnight my responses. Please note the folowing defniion: A “goverment ofc" scefned broadly and inclaes any clficer, employee or olher person acting h on officio! capacty fer the government, or any ‘business that is owned! or conroled by that govemmenl Examples of he term, “goverment official” include elected officio, party oficial, candidates far elected offce: publ sevens ‘employees of federalistate-owned enterprces and oie ‘Nor | Compliance Assessment Guedions Yer [Ne 1 [Xe you o cunort or formar gavemmant empioves? 2 | Ave you 6 crn’ or fener emeoyes of a company OwrieaBy any govemment(s)2 3 _[ We you aciose alaive (eg. erent, CN spam, soing oF nophewinioce) ‘of @ coment or formar goverment employee(s)® [ate vau eciessclatve fea. parent, chi, spouse, sbing ornephewiniece] of a current or former employee of company owned by a govemment)® lt you onswered YES o any of the above questions plecse provide the folowing: |. Last Nome and Fist Name ofthe goverment ofc): ». 2. State ‘lationship fo the government ofa:Tile or Postion ot e-government ofc) 4. General descoton o he government ofl] exponabatos 5. Organization: Indicate the nome) ol the government eiganeationlsagencyfey that the navidvats) has worked foe {6 Country whete he government ofciells} acted in an offciet copa Name of Candidates. Sprotve:..