The purpose of this questionnaire is to collect sourcing information on conflict minerals defined as tin, tantalum, tungsten and gold contained within the products/materials your company sells or delivers M&A Technology. The information collected in this questionnaire will be used by M&A Technology to comply with its reporting and disclosure obligations under the Dodd-Frank Wall Street Reform and Consumer Protection Act, Section 1502. Step 1 of 4 25% Company InfoCompany Name*Declaration ScopeDescription of ScopeDUNS No*Cage CodeAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Authorized Company RepresentativeTitleFull Name First Last Email* Enter Email Confirm Email Phone* Company Questions: (All questions are required)(1) Do you have a policy in place that includes DRC conflict-free sourcing?*YesNo(2) Is this policy publicly available on your website?*YesNo(3) Do you require your direct suppliers to be DRC conflict-free?*YesYes, included in standard contract languageNo(4) Do you require your direct suppliers to source from smelters validated as compliant to a CFS protocol using the CFS Compliant Smelter List?*YesPlanned once list become availableNo(5) Have you implemented due diligence measures for conflict-free sourcing?*YesNo(6) Do you request that your suppliers similarly certify to Conflict Minerals content in their products?*YesNo(7) Do you request smelter names from your suppliers?*YesNo(8) Do you verify due diligence information received from your suppliers?*Yes - 3rd Party AuditYes - Documentation Review OnlyYes - Internal AuditYes - All Methods ApplyNo(9) Does your verification process include corrective action management?*YesNo(10) Are you subject to the SEC Conflict Minerals disclosure requirement rule?*YesNo Mineral Questions: (Based on the Declaration Scope. All questions are required.)(1) Are any of the following metals necessary to the functionality or production of your company's products that it manufactures or contracts to manufacture? If no for ALL metals, you are done with this survey. Tantalum (Ta)*YesNoTin (Sn)*YesNoGold (Au)*YesNoTungsten (W)*YesNo(2) Do the following metals (necessary to the functionality of production of your company's products) originate from the DRC or an adjoining country? Tantalum (Ta)*YesNoUncertain or KnownTin (Sn)*YesNoUncertain or KnownGold (Au)*YesNoUncertain or KnownTungsten (W)*YesNoUncertain or Known(3) Do the following metals (necessary to the functionality of production of your products) come from a recycler or scrap supplier?Tantalum (Ta)*YesNoUncertain or KnownTin (Sn)*YesNoUncertain or KnownGold (Au)*YesNoUncertain or KnownTungsten (W)*YesNoUncertain or Known(4) Have you received completed Conflict Minerals Reporting Templates from all of your suppliers?Gold (Au)*YesNo but > 75%No but > 50%No but > 25%No but > 0% and <= 25%No - NoneTantalum (Ta)*YesNo but > 75%No but > 50%No but > 25%No but > 0% and <= 25%No - NoneTin (Sn)*YesNo but > 75%No but > 50%No but > 25%No but > 0% and <= 25%No - NoneTungsten (W)*YesNo but > 75%No but > 50%No but > 25%No but > 0% and <= 25%No - None(5) For each of the following metals, have you IDentified all of the smelters your company and its suppliers use to supply the products included within the declaration scope indicated above?Gold (Au)*Yes, all smelters have been providedNoTantalum (Ta)*Yes, all smelters have been providedNoTin (Sn)*Yes, all smelters have been providedNoTungsten (W)*Yes, all smelters have been providedNo(6) Have all of the smelters used by your company and its suppliers been validated as compliant in accordance with the Conflict-Free smelter (CFS) Program and listed on the Compliant Smelter List for the following metals?Gold (Au)*YesNoUnknownTantalum (Ta)*YesNoUnknownTin (Sn)*YesNoUnknownTungsten (W)*YesNoUnknownI hereby acknowledge that the sourcing information regarding conflict minerals (tin, tantalum, tungsten and gold) contained in our products is current, accurate and complete at the time of submission. 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