PURCHASE ORDER

	[Project n° - Unit]	[Code]	[Material Code]	[Serial n°]	[Chrono CD]
PURCHASE ORDER N°	«po_number»XXXXXX

PROJECT REFERENCE: XXXXXXXXXX - JEEVAN ORDER No:XXXXXX

ATTACHMENT 15 - REQUEST FOR SANCTIONS CERTIFICATE

(articles 7.4.1. and 7.4.7. of Global Terms and Conditions for Project Materials Purchase)

LETTER TO SUPPLIERS

Subject: [Project reference ]

Ref: [PO or contract # or ITB#]

Dear [name],

In compliance with article 7.4.1 and 7.4.7 of GTF-GPS-OOS-21001-01, Global Terms and Conditions for Project Materials Purchase (“GTC”), SUPPLIER shall ensure it is compliant with applicable Trade Control Laws under the Purchase Order (“PO”).

For the SUPPLY provided or to be provided under the above referenced contract/PO/ITB, we kindly ask you to provide us, no later than [date], with a copy of the attached Sanctions Certificate filled in, dated and signed, on your Company’s letterhead, to the attention of [name/ email address].

Should you have any questions on the foregoing or attached, please contact [name/ email address].

[Sincerely,]

[name]

[title]

TJN Ruwais Joint Venture

Technip Energies France-Abu Dhabi, JGC Corporation Abu Dhabi and NMDC Energy - P.O. Box. 7657 - Abu Dhabi, UAE

CONFIDENTIAL – Not to disclose without authorization

[on Company’s letterhead]

Sanctions Certificate

Contract/Purchase Order [PO or contract #]

We [name of supplier] certify that the SUPPLY, as defined in GTC, [description and reference], provided or to be provided under the referenced Contract/Purchase Order/Invitation To Bid [PO or contract # or ITB #] (please tick appropriately):

○ Is not originating or exported from Russia, from Belarus and from non-government controlled areas of Ukraine;

○ Does not use/incorporate any equipment, parts, components, material, mineral, inputs, etc. originating or exported from Russia, from Belarus, or from non-government controlled areas of Ukraine in the performance of the PO;

○ Is originating or exported from Russia, from Belarus and from non-government controlled areas of Ukraine, or uses/incorporates equipment, parts, components, material, mineral, inputs, etc. originating or exported from Russia, from Belarus, or from non-government controlled areas of Ukraine in the performance of the PO.

Please provide details and HS code of such product, equipment, parts, components, material, mineral, inputs, etc. part of the SUPPLY: [xxxx]

○ Are not subject to any other restrictive measures which are applicable/relevant to the performance of the PO.

○ Are subject to other restrictive measures which are applicable/relevant to the performance of the PO.

Please provide details of such restrictive measures applicable to the SUPPLY, including which jurisdiction issued such restrictive measures, what prohibitions/restrictions apply, etc.  : [xxxx]

We [name of supplier] certify that [name of supplier]:

○ Is not and has not been involved in the last 3 years in the provision of goods, technology or services in support of projects in Russia or in Belarus.

○ Is involved or has been involved in the last 3 years in the provision of goods, technology or services in support of projects in Russia or in Belarus.

Please provide details of such involvement or activities: [xxxx]

I, duly authorized to act on behalf of [name of supplier], hereby represent and certify that, to the best of my knowledge, all information provided is accurate and complete and that [name of supplier] will promptly notify Purchaser if and when any of this information is no longer true and/or any changes to the information provided are required.

[signature/name of duly authorized signatory]

[title]

[date]

-End of Letter-

TJN Ruwais Joint Venture

Technip Energies France-Abu Dhabi, JGC Corporation Abu Dhabi and NMDC Energy - P.O. Box. 7657 - Abu Dhabi, UAE

CONFIDENTIAL – Not to disclose without authorization

Project: Q-32859 - NMDC - Ruwais Folder: PO_TEMPLATE_Ruwais_rev._10