VENDOR CLASSIFICATION and SELF CERTIFICATION

In order to get your company set up as a vendor in our Enterprise system, this form must be completed and returned via email to the Siemens Product Lifecycle Management Software Inc. authorized Purchasing Agent, with the original signed copy of the W-9 or W-8 to: Siemens PLM Software, Accounts Payable Dept., 2000 Eastman Drive, Milford, OH 45150.

NOTE: IF you are a U.S. citizen or other U.S. person (refer to W-9 for definition of U.S. person for federal tax purpose), please complete the attached W-9. If you are a foreign entity or individual, please complete the attached appropriate type of W-8. Please consult with your tax advisor for the type of W-8 applied to your situation. A U.S. Taxpayer Identification Number (TIN) is required on W-8 to claim the treaty benefits.

Purchase Order Information

Vendor Name
Contact Name
Address / PO Box
City / State
Country / Postal Code
Telephone / Fax Number
Email
States that you do NOT have a sales tax permit for:

I. Business Size/Classification

The responsibility of determining the classification type for your business is yours. If you have questions, please contact your regional or district U.S. Small Business Administration office, the Minority Supply Council or the Women’s Business Enterprise Council. Please indicate, by checking the appropriate box, the following classification that is applicable to your business:

Large Business (Vendor Category A)

Small Business (SB) http://www.sba.gov/size/ (Vendor Category B)

A small business is one that is organized for profit, with a place of business located in the United States. It must operate primarily within the United States or make a significant contribution to the U.S. economy through payment of taxes or use of American products, materials or labor. Together with its affiliates, it must meet the numerical size standards as defined in the Small Business Size Regulations, 13 CFR 121 and be qualified as a small business by the U.S. Small Business Administration (SBA).

Small Disadvantaged Business (SDB) http://www.sba.gov/sdb/

(Vendor Category C)

A small business concern that is at least 51 percent owned by one or more individuals who are both socially and economically disadvantaged. This can include a publicly owned business that has at least 51 percent of its stock unconditionally owned by one or more socially and economically disadvantaged individuals and whose management and daily business is controlled by one or more such individuals. Socially and economically disadvantaged individuals include Black Americans, Hispanic Americans, Native Americans, and other individuals found to be qualified by the U.S. Small Business Administration. To qualify as an SDB, you must have certification with the U.S. Small Business Administration.

Minority Business Enterprise (MBE) (Vendor Category M)

http://www.nmsdcus.org/who_we_are/certification.html

To be eligible, your business must be 51 percent owned, operated and managed by an African American, Asian American, Hispanic American or Native American and you must be a U.S. citizen. To qualify as an MBE, you must have certification with the Minority Supplier Council.

Women-Owned Business (WBE) http://www.wbenc.org/

(Vendor Category D)

A business that has the following criteria:

·  Fifty-one percent ownership by a woman or women.

·  Proof of effective management of the business (operating position, by-laws, hire-fire and other decision-making role.)

·  Control of the business as evidenced by signature role on loans, leases and contracts.

·  U.S. Citizenship or U.S. Resident Alien Status

To qualify as a WBE, you must have certification with the Women’s Business Enterprise National Council.

None of the Above (Vendor Category A)

II.  Ethnic Origin (Please Check One)

Asian-Indian American Hispanic American Other

Asian-Pacific American Native American

Caucasian American African/Black American

Definitions:

Asian-Indian American - U.S. citizens whose origins are in India, Pakistan and Bangladesh.

Asian-Pacific American - A U.S. citizen whose origins are from Japan, China, Taiwan, Korea, Thailand, Indonesia, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific or the Northern Marianas.
Hispanic American - A U.S. citizen of true-born Hispanic heritage (true-born meaning "authentically" or "genuinely" as per Webster), from any of the Spanish speaking areas of Latin America or the following regions: Mexico, Central America, South America and the Caribbean basin only. Brazilians shall be listed under Hispanic designation for review and certification purposes.
Native American - A person who is an American Indian, Eskimo, Aleut or Native Hawaiian, and regarded as such by the community of which the person claims to be a part. Native Americans must be documented members of a North American tribe, band or otherwise organized group of native people who are indigenous to the continental United States and proof can be provided through a Native American Blood Degree Certificate (i.e., tribal registry letter, tribal roll register number). NMSDC will accept those tribes recognized by either the federal government or state government. In the case of American Indian listing on the tribal registry and acceptance by the tribe can be substituted for the 25% bloodline requirement
African American - A U.S. citizen having origins in any of the Black racial groups of Sub-Sahara Africa.
III. Certification

I certify that the information provided herein is current, accurate, and complete to the best of my knowledge.

Authorized Signature / Title / Date
Authorized Name (Printed)

Notes:

1.  This form, if submitted electronically, should be returned from the email address of the above Authorized Name, which shall then serve as the authorized signature.

2.  If you have documentation that you are a SDB, MBE or WBE, please provide a copy of your certificate with this form.

Page 1 of 3 Rev. 05/04/09