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Basic Information
* First name
* Last name
*Email
*Job Title
*Company
*Country
*Province/State
*City
*Nations Product
*Application
Issue Description
*Chip Part Number
*Version (hardware or software)
*Technical description of the potential vulnerabiltity
*How the potential vulnerability was discovered
*When the potential vulnerability was discovered
*Any public information already published or publication planning (CVE,academic paper publication,etc.)