Statement of Purpose

As Activision Blizzard, Inc. (“the Company”) employees, each of us is personally responsible for complying with the laws applicable to our business, as well as the Company's policies, procedures and guidelines.

The Code of Conduct reminds us that all employees, as well as officers and directors, must avoid situations which involve, or could appear to involve, either directly or indirectly, conflicts between their personal interests and the interests of the Company, the Company's affiliated companies or of the Company's customers, suppliers or competitors, unless the conflict is fully disclosed and approved by the appropriate Manager and the Legal Department.

If you think you may have an actual or potential Conflict of Interest, or that others could possibly perceive an activity or relationship you are engaged in may be a Conflict of Interest, you must disclose this information by completing and submitting this Report Form.

The details of your submission can only be accessed by authorized users. You may be contacted for further information or given instructions from the Company after further review of your submission. Please note that any potential conflicts that have already been reported and cleared via the Blizzard Side Project Committee do not need to be reported again on this Report Form.

Items marked with a diamond ♦ are required fields.

Your Information (You, the person completing the form)

 
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Your Information

Your Name & Contact Information

 
Prefix
(Select One)
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First Name
 
M.I.
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Last Name

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Phone Number

Include the area code, extension,
and/or dialing codes if applicable.
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Email
(Format: username@domain.com)
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Job Title

 
Employee Number
 
 
Organization
 
 
HR Generalist
 
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Employment Status
 

Your Direct Supervisor/Manager

 
Name
 
Phone Number
Include the area code, extension,
and/or dialing codes if applicable.
 
Email
(Format: username@domain.com)
   

Employee (On whose behalf this disclosure is being made)

Reported By
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Was this issue/event raised by another individual?
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Reporter Information

Your Name & Contact Information

 
Prefix
(Select One)
♦
First Name
 
M.I.
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Last Name

 
Phone Number

Include the area code, extension,
and/or dialing codes if applicable.
♦
Email
(Format: username@domain.com)
♦
Job Title

 
Employee Number
 
 
Organization
 
 
HR Generalist
 

Your Direct Supervisor/Manager

 
Name
 
Phone Number
Include the area code, extension,
and/or dialing codes if applicable.
 
Email
(Format: username@domain.com)
   

Location

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Location
   

Conflict of Interest

Note:
You may only report one type of Conflict of Interest at a time. If you have additional existing or potential conflicts of interest, submit a separate Report Form for each.
Type of Conflict
 
Select the type of existing or potential Conflict of Interest you wish to report.
(Select One)
Work, or any other activities, done outside the Company for the benefit of yourself or any other person, whether or not you are paid, which has the potential to interfere with your time commitments to the Company and/or have a negative impact on the Company's reputation. In addition to outside employment, other activities may include, but are not limited to, outside speaking engagements and appearances.

Inventions, developments, creations, etc. done on your own time which may fall within the scope of the Company's business or may compete in any way with the Company.

Making or holding investments in competitors or in companies with whom the Company does business if such investments have the effect or appearance of influencing your business judgment and duty to the Company. This also includes investments or loans to or from suppliers, customers or competitors.

Having a close relative who is employed by the Company, a supplier, customer or competitor. "Close Relative" is defined as a spouse, parent, stepparent, child, stepchild, sibling, stepsibling, nephew, niece, aunt, uncle, grandparent, grandchild, in-law and a same or opposite sex domestic partner.

Any service on a board of directors, whether or not paid. Generally, you need the Company's approval to join the board of directors of any company or other organization. That includes the approval of your Manager and the Compliance Department. Once serving on a board, you need to advise the Compliance Department of any situation that may constitute a potential or actual Conflict of Interest. If you have questions about serving on an outside board, please contact the Compliance Department.

Any transaction where you provide to, or obtain from, the Company any goods or services.

Requests for review for any gifts or entertainment, including hospitality, to be provided to a public official; as well as requests for exceptions to gift and entertainment limits under the Gifts & Entertainment Policy that require the review of the Chief Legal Officer or Chief Ethics & Compliance Officer.

Previously Disclosed
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Have you previously disclosed this existing or potential conflict of interest?
(Select One)

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Approximate date of your previous disclosure.
(Format: mm/dd/yyyy)
Outside Project
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Describe your work responsibilities at Activision Blizzard:
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Describe your outside invention or project:
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If this is a game or application, what platform will it be developed for?

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Do you plan to commercialize this invention or project, or is it just a hobby to further develop your skills?

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What is your expected completion date?

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Who else will you be working with on this, if anyone?
 
Details
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Provide as much detail as possible regarding this actual or potential Conflict of Interest where you would like guidance to help you with this situation.
 
   

Acknowledgement

Acknowledgement
♦
Acknowledgement
For your reference, please feel free to access the Company's Code of Conduct through this link, or from the menu above.

   
Note:
You should print out a copy of this completed Report Form and keep for your records.
Your Manager and the Legal Department will also keep a copy.

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