SCHLUMBERGER SOFTWARE DONATION REQUEST FORM

To be Completed by the Requestor

Request Date
Requestor's Name
Requestor’s Title
Requestor’s Email
Institution Name & Department

Institution Address & phone number

Contact Phone number:

Schlumberger contact if any

Institution’s System Admin Name &

Email:

Fully describe the intended use of

the donated software and the
individuals or groups of individuals
who will utilize the donated software.

IMPORTANT: donated Software

licenses may only be used for public
research and/or education, not for
any commercial use.

List of requested software, including

number of licenses

How many Users will utilize the

software?

Is this request for renewal of

previously donated Software
license(s)?

If so, please state the Host ID /

dongle # of the renewing license(s)

Will the donated software license(s)

be used to facilitate or provide
resources to any Government
Ministry, National Oil Company, or
any of Schlumberger’s current or
intended customers?

Does this donation violate the

requesting Institution’s policy
governance?
Requestor’s signature & date

RETURN TO NAM-DONATIONS@SLB.COM

Updated March 2014