This form must be completed by the end user (install site).
Cisco Employees, Cisco Partners and Resellers are
prohibited from completing this form for the end user.
Accurately complete the form. Incomplete or inaccurate information
will delay the transaction.
You may list multiple sites of your organization in Box 9, if you have
direct knowledge of that site's willingness to comply with the conditions
of this assurance.
Upon CISCO's acceptance of the representation made herein, the
assurance will remain in effect TWO YEARS from the date of signature.
The submission of an encryption written assurance, though required,
does not overcome the license requirement for government end users.
If you have questions, please contact
export@cisco.com.
Submissions containing abbreviations, acronyms or a P.O. Box number
will be considered invalid.
