Owner: General Counsel
Effective Date: 2026-06-14
Reviewed: Annually
Collection surface: Submitted to legal@neuroscale.ai; decision recorded in the restricted SharePoint folder owned by the CFO (compliance.insider/preclearance/<year>/)
Retention: 7 years from disposition
Complete one form per contemplated transaction. Pre-clearance, if granted, is valid for five (5) business days unless extended or revoked in writing. Pre-clearance is a procedural check, not a substantive defense — you remain personally responsible for compliance with the no-trading and no-tipping rules. See the Insider Trading Policy → Pre-clearance.

Who must use this form

Any Access Person — directors and executive officers; members of the Finance, Legal, and Executive teams; members of Sales, Business Development, Customer Success, and Corporate Development whose roles routinely expose them to MNPI; Investor Relations; and anyone designated in writing — before any of the transactions listed in §2 below. The Access Persons list is maintained by the General Counsel in coordination with the CFO.

1. Requestor

FieldValue
Full legal name{{requestor_name}}
Role / title{{requestor_title}}
Access Person category{{access_person_category}}
Date of request{{request_date}}

2. Transaction requiring pre-clearance

Select the category that applies (pre-clearance is required for all three):
  • Any transaction in Neuroscale securities, regardless of amount.
  • A transaction in the securities of a company on the active Restricted List (a public Neuroscale customer, prospect, partner, integration counterparty, or acquisition target).
  • A Rule 10b5-1 plan adoption, modification, or termination affecting either category above.

Proposed transaction details

FieldValue
Issuer / company{{issuer_name}}
Security type (stock, option, RSU, warrant, debt, derivative){{security_type}}
Side (buy / sell / gift / pledge / option exercise){{transaction_side}}
Approximate size (shares / units / notional){{transaction_size}}
Intended counterparty / venue{{counterparty}}
Intended timing{{intended_timing}}
Account in which the transaction will occur{{account}}

3. MNPI confirmation

By submitting this request, I confirm: a. I am not aware of any material non-public information (“MNPI”) about the issuer named above. I understand the definition of MNPI and the market-digestion safe harbor in the Insider Trading Policy → Definitions. b. I am not currently in a blackout period applicable to this transaction. See Insider Trading Policy → Blackout periods.

For Restricted-List trades only

FieldValue
My most recent date of contact with the issuer{{last_contact_date}}
Nature of any non-public information I received from that contact{{nonpublic_info_nature}}

4. Requestor signature

By signing, I certify that the statements above are true and complete, that I have read the Insider Trading Policy, and that I will not transact unless and until written pre-clearance is granted and remains valid. Requestor Signature: _______________________________ Printed Name: {{requestor_name}} Title: {{requestor_title}} Date: ___________________________________

5. General Counsel decision (office use)

FieldValue
Decision{{decision}} (Approved / Denied)
Conditions or notes{{decision_notes}}
Pre-clearance valid through (5 business days unless extended){{valid_through_date}}
General Counsel Signature: _______________________________ Printed Name: {{gc_name}} Title: {{gc_title}} Date: ___________________________________
If the General Counsel becomes aware of MNPI about the issuer during the validity window, this pre-clearance is revoked automatically and the requestor will be notified.

Variables

VariableDescription
{{requestor_name}}Requestor’s full legal name
{{requestor_title}}Requestor’s title or role
{{access_person_category}}Access Person category (e.g., “Executive officer”, “Sales — public counterparty exposure”)
{{request_date}}Date the request is submitted (YYYY-MM-DD)
{{issuer_name}}Name of the company whose securities will be traded
{{security_type}}Type of security
{{transaction_side}}Buy / sell / gift / pledge / option exercise
{{transaction_size}}Approximate size of the transaction
{{counterparty}}Intended counterparty or trading venue
{{intended_timing}}When the transaction is expected to occur
{{account}}Account in which the transaction will occur
{{last_contact_date}}(Restricted-List only) Most recent contact date with the issuer
{{nonpublic_info_nature}}(Restricted-List only) Nature of any non-public information received
{{decision}}”Approved” or “Denied”
{{decision_notes}}Conditions or notes on the decision
{{valid_through_date}}Last day the pre-clearance is valid
{{gc_name}}General Counsel’s printed name
{{gc_title}}General Counsel’s title

Cross-references


Version history

VersionDateDescriptionAuthorApproved by
1.0June 14, 2026Initial versionCameron WolfeIshan Jadhwani