SYMANTEC LICENSE ASSIGNMENT REQUEST FORM
Instructions to Requesting Party
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Please complete and sign this form to request the assignment of Symantec Product licenses to the new End User. Certain sections of this request form may not be applicable to you depending on the Symantec Products you are requesting to be assigned. Please complete only the sections that are applicable to your request. If additional space is needed, please provide the required information on a separate paper referencing this License Assignment Request Form (“LAR”) and attach it.
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This License Assignment Request form is only intended to assign your licenses with Symantec and supplementary end user license agreement or shrinkwrap. Request to assign the license agreement with Symantec should be sent by the customer on the company’s letterhead to Symantec addressed to the Director of Contracts. They will be reviewed and processed in accordance with the customer’s existing agreement with Symantec and Symantec’s License Assignment Policy.
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Once you have completed this request form, depending on your location, please submit your request to one of the addresses, e-mail addresses, or faxes listed below. Please note that original copy of the emailed or faxed LAR is required to process the LAR.
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In the America’s email osg.amer.cia@symantec.com or fax at: 650-527-0952
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In Asia Pacific email apac_cia@symantec.com and Japan: japan_cia@symantec.com
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In EMEA email emea_customercare@symantec.com or fax at +353 1 8035962
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Upon receipt of the completed and signed request form, Symantec will review your request and contact you if additional information is needed.
Please Note: Failure in providing current, accurate, and complete information may result in a delay in processing of the LAR.
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Section I: Current User Information
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*Company Name:
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*Street Address, City, State/Province, Country and Postal Code:
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*Phone Number:
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*Facsimile Number:
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*Contact Name & Title:
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*Contact’s E-mail Address:
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Section II: New User Information
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*Company Name:
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*Street Address, City, State/Province, Country and Postal Code:
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*Phone Number:
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*Facsimile Number:
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*Contact Name & Title:
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*Contact’s E-mail Address:
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Section III: General Information
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1.
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*Please indicate or state the reason for the assignment request:
Merger or Acquisition (your company has combined with, acquired another company, or is acquired by another company). Please include a public announcement, such as a press release, or a letter on your company letterhead describing the merger and acquisition.
Divestiture of a Business Unit (sale or other disposition of one or more of your business unit) – Note: A divestiture is not the same as a Partial Asset / Liquidation Sale.
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Bankruptcy Related Sale (Note: All assignment requests due to bankruptcy are subject to review and approval by Symantec U.S. Legal Department.)
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Other (please explain in detail in the space provided): ____________________________________________________________________
_______________________________________________________________________________________________________________________
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2.
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*Insert the date the assignment is to be effective (“Effective Date”): (This should reflect the date when you require the assignment to become effective. Unless you specify a date, the Effective Date will default to the date Symantec completes the processing of you request.) ___________________
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Section IV: Specific Symantec Product Information
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In Sections IV 1 (a) and 1 (b) indicate the type(s) of agreement under which the Symantec Product(s) being assigned were originally purchased:
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1(a).
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*Complete This Section For The Following Product Families: Data Back-up and Recovery, Archive and Retrieval, High Availability, Storage and Server Management and Application Performance Management.
If purchased directly or through Reseller/OEM/Distributor please include and indicate the following information:
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License Agreement included in the Box (i.e. End User License Agreement)
Software License and Services Agreement (SLSA) – Insert the corresponding Contract Number (if any): _________________________
Site License Addendum (i.e. Limited Site License Addendum, Unlimited Site License Addendum, Enterprise Flex Site License Addendum, etc.): Indicate the type of Site License: _______________________________________________ and insert the corresponding Contract Number (if any): _________________________________
Volume Purchase Addendum – Insert the corresponding Contract Number (if any): _________________________
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Reseller/OEM/Distributor Name:
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Street Address, City, State/Province, Country and Postal Code:
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VIP Program
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1(b).
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*Complete This Section For All Other Product Families:
Contract(s) (i.e. Global License Program, Elite Program, Enterprise Program, etc.) – Insert the Contract Title and Contract Number:
_____________________________________________________________________________________________________________________
Certificate(s) (i.e. Symantec’s Value Program)
For purchases made under the Contract(s) and/or Certificate(s) referenced above, please choose from the options below the type(s) of assignment(s) being requested and insert the corresponding Certificate Number(s) and/or Serial Certificate Number(s). Only current maintenance / technical support services (“Maintenance/Support”) may be assigned with the corresponding Symantec Product(s).
Appliances only: ______________________ (Serial Certificate Number)
Appliances and Maintenance/Support:
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Appliance Serial Certificate Number: ______________________
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Maintenance/Support Certificate Number:______________________
Licenses only: ______________________ (License Certificate Number)
Licences and Maintenance/Support:
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License Certificate Number: ______________________
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Maintenance/Support Certificate Number: ______________________
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2.
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*Where would the Symantec Product licenses be located once the assignment is complete?
They will remain on the current computer systems
They will be transferred to new computer systems
They will be moved to a new geographic location or data center
Please provide the new address and contact information on the lines below for the location where the product will now be installed:
New street address, city, state, zip code: _________________________________________________________________________
__________________________________________________________________________________________________________
Contact information for new user including full name, email and phone number: ___________________________________________
__________________________________________________________________________________________________________
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3.
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*Are the Symantec Product(s) currently under maintenance and support? YES NO
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4(a)
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*Please list below the Symantec Product(s) to be assigned and include, if any, the corresponding current Maintenance/Support End Date, if Maintenance/Support are being assigned. Please note that Maintenance/Support cannot be assigned alone nor can expired Maintenance/Support be assigned.
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For purchases made through VIP Program a Sales Order Number is required.
ORDER NO., SALES ORDER NO., & PURCHASE ORDER NO. **
| PRODUCT DESCRIPTION | SYMANTEC PART CODE OR SKU NO. |
INSTALLED LOCATION (INSERT COMPLETE ADDRESS) **
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SERIAL NO. AND HOST ID NO. **
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MAINTENANCE & SUPPORT END DATE:
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QUANTITY
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** These fields are required for requests related to the following Symantec Product families: Data Back-up and Recovery, Archive and Retrieval, High Availability, Storage and Server Management and Application Performance Management.
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4(b).
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If current Maintenance/Support is being assigned in 4(a) above, please indicate below the Maintenance/Support contact information for the new user. If current Maintenance/Support is not being assigned in 4(a) above, then leave the following fields in this section blank.
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Contact 1: Contact 2:
Product: ______________________________
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Product: ______________________________
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Contact Name & Title:
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Contact Name & Title:
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Address:
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Address:
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Email Address:
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Email Address:
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Phone Number:
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Phone Number:
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Fax Number:
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Fax Number:
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Acknowledgement By Current User
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I. By your signature below, you agree that you will assign the Symantec Product(s) and any applicable current Maintenance/Support identified in Section IV 4(a) to the new user, on a one time, not-for-profit permanent basis, as of the Effective Date. Additionally, by signing below, you certify that as of the Effective Date of the assignment, you will destroy and/or delete all copies of the Symantec Product(s) or, if applicable, portions thereof then in your possession, including but not limited to any electronic copies stored in memory or on any storage device or medium and any back-up, archival or disaster recovery copies of the Symantec Product(s) and documentation. At Symantec’s reasonable request, an authorized representative of your company shall certify in writing to Symantec and provide evidence to support that all copies of the assigned Symantec Product(s) or, if applicable, portion thereof in your possession have been destroyed or deleted.
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II. Upon receipt of this signed request form, Symantec will adjust its records to reflect that you no longer hold the number of the Symantec Product(s) requested for assignment herein. Additionally, Symantec will void all of the Certificate(s) referenced in Section IV 1(b) and will issue a replacement Certificate(s) to you reflecting the remaining licenses and, if applicable, Maintenance/Support for the Symantec Product(s). At the same time, Symantec will issue a new Certificate(s) to the new user reflecting the number of licenses and, if applicable, the Maintenance/Support for the Symantec Product(s) being assigned herein. All new or replacement Certificate(s) will be computer-generated automatically and will be sent to you and the new user at the address specified in this request form.
III. For Symantec’s Data Back-up and Recovery, Archive and Retrieval, High Availability, Storage and Server Management and Application Performance Management Product family licenses being assigned, which are listed under Section IV 4 (a), Symantec will provide written notification to you and the new user of Symantec’s consent to your assignment request. Unless you have received such written notification from Symantec, for the Symantec Product families listed in the preceding sentence, your request has not been approved by Symantec and you may not assign the licenses for such Symantec Products to the new user. Any assignment, without such written notification from Symantec, will be considered null and void and will subject such licenses to immediate termination without notice from Symantec.
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IV. All use of the Symantec Product(s) will be under the then current license terms and conditions reflected on the new or replacement Certificate(s), if applicable under this License Assignment Request form, and/or Symantec’s license and warranty agreement that accompany the standard retail version of the Software Product(s) (also known as the end user license agreement or the “EULA”). Symantec reserves the right to revoke its consent at any time without any requirement of notice, should it be determined by Symantec that the information provided by you in the License Assignment Request form is either false or incorrect. Please note that any unauthorized use of Symantec Product licenses is unlawful and Symantec reserves all of its legal rights and remedies..
By signing and submitting this License Assignment Request form, you certify that (i) the information provided above is current, accurate and complete; (ii)
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you are the current license holder of the Symantec Product(s) being requested for assignment, (iii) you have authority to sign this License Assignment Request form on behalf of yourself, if you are an individual, your organization or company; and (iv) you acknowledge and agree to all the terms and conditions stated above for the assignment of the licenses listed herein.
Agreed and accepted by:
Current User
Company Name: ________________________________
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Signature:
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Name:
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Title:
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Date of Request:
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PLEASE BE SURE TO CHECK YOUR LICENSE ASSIGNMENT REQUEST FORM TO ENSURE THAT ALL REQUIRED FIELDS ARE FILLED-IN APPROPRIATELY TO PREVENT ANY DELAYS IN PROCESSING YOUR REQUEST.
*=This is a required field.
Symantec License Assignment Request Form Symantec Corporation – Confidential
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