--------- Free-of-Charge Problem-Fixed M30870T-EPBM Board ----STARTED----
                         Application Form

TO: Your local Renesas Technology sales office or distributor

Effective Date of Application: From January 16, 2006

             Free-of-Charge Problem-Fixed M30870T-EPBM Board
                          Application Form
       -------------------------------------------------------------

Date of Application:

Product Type:
Serial No.:
  (Be sure to enter the serial number of yours. It is inscribed on the 
   bottom side of the compact emulator/emulation probe.)

FROM:
  Customer Company:
  Customer Section:
  Customer Contact Person:
  Address:
   City                      State                 Zip
                             Country
  Phone:                          Extension:
  FAX:
  E-mail Address:

Message:



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--------- Free-of-Charge Problem-Fixed M30870T-EPBM Board -----ENDED-----
                         Application Form