Export Compliance and Data Privacy Written Assurance (ECWA) Form

Temporary Employees and Consultants

I. Export Compliance
Qualcomm’s hardware, software, source code and technology (“products”) may be subject to U.S. export
control laws, including the U.S. Department of Commerce’s Export Administration Regulations (“EAR”, 15
CFR 730 et seq.) and the U.S. Department of State’s International Traffic in Arms Regulations (“ITAR”, 22
CFR 120 et seq.). Therefore, export authorization or licensing by the U.S. government may be required
prior to the export, re-export, transfer or release (“export”) of Qualcomm products to non-U.S. nationals.1
To enable Qualcomm to disclose certain export-controlled technologies and software in compliance with
the requirements of the EAR and ITAR, the undersigned must provide the following assurance:

II. Assurance
Qualcomm and its employees, temporary employees and consultants worldwide have a responsibility to
comply with U.S. and all applicable global export laws including countries where Qualcomm does
business. The undersigned will use Qualcomm approved export systems and processes and will not
export, directly or indirectly, any products obtained from Qualcomm or the direct products thereof to any
destination, person, entity or end use prohibited or restricted under U.S. law without prior U.S.
government authorization to the extent required by regulation, and with prior written authorization from
Qualcomm Export Compliance. The undersigned agrees not to knowingly directly or indirectly export any
product received from Qualcomm to any party listed on any of the denied parties’ lists or specially
designated nationals lists, or that is otherwise subject to U.S. sanctions or trade restrictions, without prior
U.S. government authorization to the extent required by regulation. The U.S. government currently
maintains comprehensive embargoes and sanctions against Cuba, Iran, North Korea, Sudan (N), Syria
and Crimea region of Ukraine, but any amendments to these controls shall apply.

Failure to comply with U.S. export control laws may subject Qualcomm to loss of export privileges, fines
and/or criminal prosecution. Furthermore, the undersigned’s failure to comply with these regulations could
result in termination of the undersigned’s assignment with Qualcomm and prosecution by the U.S.
government. The terms of this written assurance shall survive the expiration or termination of the
engagement, assignment, or visit with Qualcomm, and any related agreement.

III. Name and Citizenship

The following questions are asked for the purpose of complying with the EAR and ITAR.
Manisha Dash
1. Name of individual:

2. Are you any of the following “Protected Individual(s)” as defined in the Immigration and Naturalization
Act, 8 U.S.C. 1324B(A)(3):
- A United States citizen or national; or
- A person lawfully admitted for permanent residence of the United States (i.e., “Green Card”
holder); or
- An INS-approved refugee or asylum holder who has applied for naturalization within six months of
the date the individual first became eligible; and if not yet naturalized, is still actively pursuing
naturalization if 2 years have passed since the date of application.
Yes

No x

1
For purposes of U.S. export law, a U.S. national is a person who is a U.S. citizen, lawful permanent resident (green
card holder), or a protected individual (in the U.S. with approved political asylum or refugee status) as defined under
the Immigration Naturalization Act.

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3. Citizenship and Visa/Work Authorization:
a. What is the country of your birth? INDIA

b. List all countries of which you are a citizen and, if applicable, the date you obtained citizenship:

INDIA
c. List any additional countries of which you are a lawful permanent resident and, if applicable, the date
you obtained permanent residency: NA
Indicate “Not Applicable” if you do not have lawful permanent residence status in a country other than
the country(ies) indicated above in response to questions 3(a) and 3(b).
d. Visa status and/or work authorization:
If applicable, indicate the type of valid visa and expiration date and/or work authorization you have
from the U.S. or other country.
Any service, assignment or engagement provided to Qualcomm by a non-U.S. national requires review by
Qualcomm Export Compliance (export.fn@qualcomm.com) and may be contingent upon the acquisition of
any required export license or authorization from the U.S. government.

IV. Data Privacy Consent

I consent to the collection, use, processing and transfer of personal data as described in this paragraph. I
understand that by completing and signing this form, Qualcomm will hold certain personal information
about me including my name, contact information, birth country, country of citizenship, permanent
resident status, and dual citizenship/nationality (“Personal Data”), in order to determine if an export
license will be required, and for the purpose of any required authorization from applicable government(s).
I further understand that Qualcomm will transfer Personal Data amongst its affiliates as necessary for the
purpose of determining and obtaining such government authorizations, and that Qualcomm may further
transfer Personal Data to any third parties including government entities assisting Qualcomm in
determining and obtaining any government authorizations required. I understand that these recipients
may be in the U.S. and elsewhere. I authorize them to receive, possess, use, retain and transfer the
Personal Data, in electronic or other form, for the purposes described in this paragraph. I understand that
I may, at any time, review the Personal Data, require any necessary amendments to it, or withdraw my
consent herein by contacting Qualcomm. I understand that withdrawing my consent may affect my
assignment or other status with Qualcomm.

V. Signature
This form should be reviewed, completed, and forwarded directly or through applicable representatives to
Qualcomm Human Resources, Contingent Workforce Department or Representative.

I hereby certify that I have read and understand this assurance, agree to all that is stated, and confirm that
all information provided is accurate.
Manisha Dash

Print / type legal family name (surname) Signature

Legal first name (given name)
as appears on your birth certificate or passport
E-II 11/02/2023
Job title Date

Alten calsoft Labs (India) Pvt. ltd. Bangalore

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Name of your employer (company that pays you) Location of employer (city, country)

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 Alten calsoft Labs (India) Pvt. ltd. 89842 33979
Name of company that Qualcomm has an agreement Personal mobile number
or contract with, if different than above
manisha.95lucky@gmail.com
Name of primary Qualcomm employee Personal email
contact/sponsor/lead if known

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