Alert Report Form / Alert System / Who are we? / Ceva Corporate

Confidentiality and Anonymity

1. I give permission to the recipient of this form to share my personal information with those who are directly involved in the investigation of the possible misconduct described in this form. *

Yes

No

2. If legally permissible under the laws of the country where I operate, I wish my report to be treated anonymously (if yes, do not fill in personal information section below) *

Yes

No

Personal information

3. Your name (first and last name):

4. Your preferred phone number (this may be your private phone number):

5. Your preferred e-mail address (this may be your private email address):

6. Best time to communicate with you (including time zone you are in):

7. Best way to communicate with you:

8. Preferred (or available) language for communication: *

English

French

Other

9. If other language, enter text below

10. Name of your operating company / corporate department:

Report of possible misconduct

11. What type of possible misconduct do you want to report?

12. If others misconducts, enter text below

13. What is the possible misconduct you want to report?

14. When did it occur? (Please estimate if exact dates are not known)

15. Where did it occur? (Please fill in the location, document or transaction, as applicable)

16. Who, in your opinion, are the persons involved? (Please fill in the first and last names and functions to the fullest extent possible)

17. What, in your opinion, is the potential damage (financially or otherwise) to Ceva Group? (To the extent you have visibility on this)

18. Is the situation still happening? *

No

Yes

Not sure

Personal action

19. How did you become aware of the situation?

20. Have you reported the situation to anyone else within Ceva Group first? If NO, please enter text below

21. Have you reported the situation to anyone else within Ceva Group first? If YES, please enter text below

22. Do you know of any other person(s) who is/are aware of the situation, but who is/are not personally involved?

23. If Yes, please include name(s) of person/people to the extent you feel comfortable doing so, and describe the physical evidence you may have (such as documents)

24. Please provide any additional information you have which you believe may be relevant:

25. *

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