SECURITY CHECKLIST

Please supply one check-list only per company.

Since 1976 Intergraf is organizing every 18 months the International Security Printers’ Conference, which aims to discuss trends and new

developments in printing and security technology, and in fighting forgery and counterfeiting. Since 1991 an exhibition has been organized alongside the

conference. It offers printers and suppliers the opportunities to present their technology and know-how.

The participation in the conference and exhibition and the circulation of InfoSecura, the free of charge Newsletter for the Security Printing Industry, are

restricted to representatives of ministries, central and commercial banks, savings banks, post banks and post offices, police institutions, forensic

laboratories and institutes, high and general security printing houses, card producers, suppliers and public authorities.

The quality of our conference program as well as the content of our newsletter rely on the assurance for the authors and speakers that our audience is

restricted to duly verified companies. To receive our publication InfoSecura and an invitation to our International Security Printers’ Conference and

Exhibition, please fill-in your company details below and forward us the requested information to assess your eligibility. Your application will be

considered by our ad-hoc committee and you will be informed about our decision within 2 months after the receipt of your documentation. Please note

that this data will be used for all further contacts. If one of your employees is located at a different address, please give his/her details on a separate

sheet. We thank you very much in advance for sending us this form duly signed by the official representative of your company/institution as well as the

necessary documentation to:

INTERGRAF, Avenue Louise 130A bte 2 – 1050 Brussels – Belgium or by fax to +32 2 231 14 64

For any question, please contact Intergraf by e-mail to securityprinters@intergraf.eu, by phone at: +32 2 230 86 46 or by fax to +32 2 231 14 64.

All information and personal data entered in this form will be used only for mailing our newsletter INFOSECURA, our invitation brochure and

information material concerning the Intergraf activities. The data will not be forwarded or communicated to any third party without your prior

approval. You can at all time contact Intergraf (see details above) to consult your personal data, modify them or demand to be removed from

our database.

COMPANY DETAILS:

Company name: ………………………………………………………………………………………………………………………………………………………...….

Company address: …………………………………………………………………...…………………………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………………………...

Postal Code ……………….....City ……………………………..……………………………..State/Region …………………………………….…………….………

Telephone: + ……………………………….………………………..……………. Fax: + ……………………………….………….…………….…………………….

E-mail: ……………………………………………………………...……………… Website: ………………………………………...………………………………….

List of contacts who should receive InfoSecura and the invitation to our Conference:

Title First Name Family Name Function Department E-mail

Mr, Ms,

Dr or

Prof.

Reference for internal use only:

Is your company/institution:

□ a ministry,

□ a central bank

□ a commercial bank, savings bank or post bank

□ a post offices or a postage stamps issuing authority

□ any other public issuing authority

□ any other private issuing authority

Please specify what kind of document your administration/institution is issuing.

□ police institutions, forensic laboratories and institutes

Please specify your involvement or area of interest in the Security Printing Industry.

□ a security printing house

□ a card producer

a. Description of security product range and scope (markets):

b. Total number of employees

c. Number of employees involved in Security

Printing

d. Total turnover

e. Turnover in Security Printing

Please forward to INTERGRAF together with this form either letters of reference from 2 renowned customers or samples of 2 products produced

within the last 12 months. Please note that this information will be kept confidential and will only be used for the purpose to establish that your

company is a Security Printer. The samples will either be destroyed or returned to your company upon request.

□ I enclose 2 letters of reference.

□ I enclose samples of 2 products and want you to destroy them.

□ I enclose samples of 2 products and want you to send them back to my company

□ a supplier to the Security Printing Industry

a. Description of security product range and scope (markets):

b. Total number of employees

c. Number of employees involved in Security

Product

d. Total turnover

e. Turnover in Security Product

Please forward to INTERGRAF together with this form either letters of reference from 2 renowned customers or samples of 2 products produced

within the last 12 months. Please note that this information will be kept confidential and will only be used for the purpose to establish that your

company is a Supplier to the Security Printing Industry. The samples will either be destroyed or returned to your company upon request.

□ I enclose 2 letters of reference.

□ I enclose samples of 2 products and want you to destroy them.

□ I enclose samples of 2 products and want you to send them back to my company

The undersigned is a duly authorized representative of the company ………………………………………………………, located in

…...………………………………..(city/country). I acknowledge that the information on this form and the documentation enclosed are true and genuine

and that the undersigned is an official employee of the company.

Date: ………………………………… Name: .……………………………………….…………………………… Signature: …………………………………………