LICENSE ASSURANCE / DISCLOSURE FORM
MEMBER/LICENSEE PROVIDING ASSURANCE / DISCLOSURE:

RETURN INFORMATION:

Organization / Company: ________________________________To be completed, signed, and returned via mail,e-mail (.pdf), or facsimile toAuthorized Representative:
Name:_______________________________
Title:___________________________________

Stan Moyer, Executive Director
SD Card Association
5000 Executive Parkway, Suite 302
San Ramon, CA 94583
Fax: (925) 275-6615e-mail: helpdesk@sdcard.org

Note: Capitalized Terms used in this Form shall have the meanings set forth in the SD Card
Association Intellectual Property Policy (“IP Policy”) unless otherwise defined herein.

PART 1:

TO BE COMPLETED BY THOSE MAKING A CONTRIBUTION AS DEFINED BY SECTION 5 OF THE IP POLICYMember is providing Submitted Materials in conjunction with its Contribution and hereby grants the SDA a nonexclusive, perpetual, irrevocable, sub-licensable (through multiple tiers), royalty free, worldwide license to the SDA touse, reproduce, modify, prepare derivative works of, distribute, publicly display and/or perform the Submitted Material
and/or any derivative thereof. Member (on behalf of itself and any employees, contractors, consultants or agents
involved in the creation of such Submitted Material) hereby waives and agrees not to assert any and all moral rights,including, without limitation, any right to identification of authorship or limitation on subsequent modification in such
Submitted Material. Member also represents and warrants that to its knowledge (a) no information in such Submitted
Material is confidential (except as such material may be incorporated in the Specifications as set forth in Section 6 ofthis IP Policy) and that the SDA may freely disclose such information, (b) there are no limits to the Member’s ability tomake the grants, acknowledgements and agreements herein, and (c) the Member has not included in the materials any
information which is defamatory, untrue or which is illegal under the laws of the jurisdiction in which the Member has
its principal place of business..

Member has patent claims which read on the Contribution and/or the practice thereof such that Member believes that if
such Contribution were to become part of an Adopted Specification such claims may be Essential Patent Claims. [Note: ifchecked, Contributor should complete Part 2; provided that, in the case of a Relevant Specification as defined by and inaccordance with Section 5 of the IP Policy, such Contributor shall not be allowed to withdraw from the commitment tolicense Essential Patent Claim(s) that implement such Contribution, alone or by combination of the Contribution withsuch Relevant Specification, in a non-discriminatory fashion, and on reasonable terms]
PART 2:A.

TO BE COMPLETED BY THOSE MAKING A DISCLOSURE OF ESSENTIAL PATENT CLAIMS EITHER (A) AT THE TIMEOF MAKING A CONTRIBUTION, (B) DURING THE NOTICE PERIOD AS DEFINED BY SECTION 5 OF THE IP POLICY;AND/OR (C) SUBSEQUENT TO THE NOTICE PERIOD WHEN A LICENSEE FIRST BECOMES AWARE OF SUCHESSENTIAL PATENT CLAIMSPATENT HOLDER AND CONTACT FOR LICENSE DISCUSSIONS:Name of Patent Holder: _________________________________________________________________________________Contact Name & Department: _______________________________________________________________________________
Address: _______________________________________________________________________________________________
Telephone: ____________________ FAX: ___________________ E-mail: _____________________________________B.

IDENTIFICATION OF PROPOSED AND/OR ADOPTED SDA SPECIFICATION::

Part and Version Number: ____________________________________________________________________________
Title/Description of Specification: ___________________________________________________________________________C.

PATENT HOLDER’S STATEMENT REGARDING LICENSING OF ESSENTIAL PATENT CLAIMSIn accordance with Section 5 of the IP Policy, the Patent Holder hereby declares that its licensing position with respect to any
patent claims, existing and pending, which are required to implement the Adopted Specifications, or the ProposedSpecifications, if Adopted (check one box only):
1.

The Patent Holder agrees to license its Essential Patent Claims in a non-discriminatory fashion for use in such
implementation, on such terms as are attached hereto, to all Licensees of the Specification as adopted by the SDA.

2.

The Patent Holder agrees to license its Essential Patent Claims in a non-discriminatory fashion for use in suchimplementation, upon reasonable terms and conditions as provided in Section 2 of the IP Policy, with orwithout charge, to all Licensees of the Specification as adopted by the SDA; or

3.

The Patent Holder does not agree to license in connection with any or all of the implementations described inthe Specification, in which case the SDA may not include such Patent Holder's proprietary technology in theSpecifications.

[Note: pursuant to Section 5 of the IP Policy, Registered Participants, Unregistered Participants (except in the case of Early
Notification and Withdrawal), and those parties disclosing after the conclusion of the Notice Period must agree to license
in a non-discriminatory fashion, and on reasonable terms, to all other Licensees, such participant’s/parties’ Essential PatentClaims.]
D.

IDENTIFICATION OF ESSENTIAL PATENT CLAIMSPatent Holder hereby discloses the following Essential Patent Claims which the Patent Holder believes are required toimplement the Specifications identified in Section B above: [Note: nothing herein shall give rise to an obligation to conducta patent search.].
Patent Information Required[Note: In the case of unpublished Essential Patent Claims: (i) if item C.2. is checked, merely indicate the existence of theapplication until publication, or (ii) if item C.3. is checked, identify the portions of the Proposed Specification on which theEssential Patent Claim reads. In either case, a follow up completed disclosure schedule is required upon publication.]
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Application and orRegistration Number /Country / Filing and orIssuance DateTitle / InventorStatus[issued /publishedpending /unpublishedpending]

E.

IRREVOCABILITY / TRANSFER OBLIGATIONSThis License Assurance and Disclosure Form is irrevocable. If a subsequent License Assurance and Disclosure Form covering
previously disclosed information is submitted, the subsequent License Assurance and Disclosure Form may only supersede theprior License Assurance and Disclosure Form if the subsequent License Assurance and Disclosure Form is less restrictive onprospective Licensees than the former License Assurance and Disclosure Form. The License Assurance and Disclosure Form willapply to the Specification and any revisions to that Specification.
This License Assurance and Disclosure Form and licensing obligations reflected hereunder is intended to be binding upon any
and all successors-in-interest and transferees of any Essential Patent Claim(s) covered by such License Assurance and Disclosure
Form. Member agrees (a) to provide notice of and bind such successors-in-interest and transferees in writing to the terms ofthis License Assurance and Disclosure Form; and (b) to require its successors-in-interest and transferees to (i) agree to similarly
provide such notice and bind its successors-in-interest and transferees; and (ii) to impose obligations on downstream successorsin-interest and transferees as described in (a) and (b).
IN WITNESS HEREOF, executed by the party’s authorized representative as of the date set forth below and irrevocable upon
acceptance by the SDA Board.

Signature: ______________________________________________
Print Name: ___________________________________________
Organization/Company: __________________________________
Title/Position: __________________________________________

Date: