Fillable Counterfeit Validation Form (Texas Instruments)

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Counterfeit Validation Form (Texas Instruments)

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Counterfeit Validation Form
Rev B
IMPORTANT NOTES
In order for Texas Instruments (TI) to provide verification and analysis services, all information as specified in this “Counterfeit Validation Form” is
required. Incomplete, unclear and or inaccurate information may result in the delay of analysis as well as the limited depth of the analysis. Customers
who do not purchase directly from TI, must first involve their distributor to resolve issues.
TI will not provide verification and analysis services for parts purchased through unauthorized sources (brokers, independent distributors, or 3rd party
test houses) due to the uncertainties concerning product custody and the supply chain through which such parts may have been obtained.
Furthermore, TI will not provide warranty coverage for any device purchased through unauthorized sources. TI is strengthening our customer return
policies to help ensure our authorized supply c
hain is free of counterfeit and untrustworthy
material. TI is committed to keeping TI products out of
unauthorized channels, as well as identifying and stopping counterfeiting of TI products. We appreciate your support in helping us maintain a secure
supply chain by providing all of the requested information.
Email an electronic copy of this “Counterfeit Validation Form” to
ti-counterfeit@list.ti.com
and your Texas Instruments contact.
Customer Contact: Please fill in your contact information, Required
Inquiry Date:
Company Name:
Contact Person:
Phone:
E-Mail:
Website:
Sales Channel: First involve the distributor. An authorized distributor of TI should be able to support your inquiry.
Parts were bought directly from Texas Instruments?
Parts were bought from a TI authorized Distributor?
Distributor Name:
Distributor Address:
Distributor Site / Location:
Distributor Contact E-Mail Address:
Distributor Website:
Product Details:
Device Quantity:
Texas Instruments Part #:
Customer Application:
Consumer:
Medical:
Industrial:
Automotive:
Telecom:
Avionics / Military / Space:
Computer:
Other:
Required Images (High Resolution photos)
• Completed Counterfeit Request Form
• High Quality Pictures of Bottom & Top of the device
• High Quality Pictures of the TI 2D bar code labels
• Copies/Pictures of Shipping documents, i.e packing slip showing the origin of devices to TI.
(If this information cannot be provided we are unable to provide verification due to uncertainties
regarding chain of custody of the products.)
Address:
-
-
IMPORTANT NOTICE AND DISCLAIMER
TI PROVIDES TECHNICAL AND RELIABILITY DATA (INCLUDING DATASHEETS), DESIGN RESOURCES (INCLUDING REFERENCE
DESIGNS), APPLICATION OR OTHER DESIGN ADVICE, WEB TOOLS, SAFETY INFORMATION, AND OTHER RESOURCES “AS IS”
AND WITH ALL FAULTS, AND DISCLAIMS ALL WARRANTIES, EXPRESS AND IMPLIED, INCLUDING WITHOUT LIMITATION ANY
IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT OF THIRD
PARTY INTELLECTUAL PROPERTY RIGHTS.
These resources are intended for skilled developers designing with TI products. You are solely responsible for (1) selecting the appropriate
TI products for your application, (2) designing, validating and testing your application, and (3) ensuring your application meets applicable
standards, and any other safety, security, or other requirements. These resources are subject to change without notice. TI grants you
permission to use these resources only for development of an application that uses the TI products described in the resource. Other
reproduction and display of these resources is prohibited. No license is granted to any other TI intellectual property right or to any third
party intellectual property right. TI disclaims responsibility for, and you will fully indemnify TI and its representatives against, any claims,
damages, costs, losses, and liabilities arising out of your use of these resources.
TI’s products are provided subject to TI’s Terms of Sale (www.ti.com/legal/termsofsale.html ) or other applicable terms available either on
ti.com or provided in conjunction with such TI products. TI’s provision of these resources does not expand or otherwise alter TI ’s applicable
warranties or warranty disclaimers for TI products.
Mailing Address: Texas Instruments, Post Office Box 655303, Dallas, Texas 75265
Copyright © 2020, Texas Instruments Incorporated
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Counterfeit Validation Form (Texas Instruments)

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Completed 24 June 2021

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