Customer Name:
Customer Number:
Country:

Siemens Corporation

CUSTOMER PRESHIPMENT EXPANDED EXPORT SCREENING (“EES”)

Customer Name: Customer Number:

(i.e., Server/Sold To/Install/Ship To)

The Sales Representative and/or Indirect Sales Manager responsible for the customer relationship must complete the Customer Profile section below and Attachment A hereto. ALL INFORMATION MUST BE COMPLETED. Approval from the Siemens PLM Solutions Export Compliance Department may be delayed if information is omitted.

REASON FOR NEW PAPERWORK (Check all that apply): / TYPE OF ORDER:
New Customer (Order Pending) / SAP Order
New Customer (EES Pre-Approval/No Order Pending) / SAP MRO/Update Order
Existing Customer
Customer Name Change
Customer Address Change
Current EES is over 2 years old
CUSTOMER PROFILE

CUSTOMER INFORMATION:

Name: (provide the full customer name and any acronyms or abbreviated names used by this customer)

Address

Does this Customer design/manufacture, produce products for military and/or commercial use?

Please check all that apply:

Military

Commercial

Type of Business: (i.e., Aerospace, Consumer Products, Distributor/Reseller, Educational/Institute of Science or

Technology, Military/Defense, Research & Development, Tool & Die, Transportation, Manufacturing)

Educational/Institute of Science or Technology

Detailed description of customer’s business, including what items they design, develop or manufacture and/or other services provided: Educational/Institute of Science or Technology

Intended End-Use of the SIEMENS PLM Solution’s Products: (be specific, one to five word descriptions are not acceptable)

Is Customer a Distributor or Reseller?YES NO

(A Letter of Assurance is required for all Distributors and Resellers)

a.Letter of Assurance on file? (If yes, please provide a copy)YES NO

EXPANDED EXPORT SCREENING SUMMARY:

  1. DENIED PARTIES LIST SCREEN: Is the customer listed on the MK Technology Denied Parties List? If the customer is listed, then contact the SIEMENS PLM Solutions Export Compliance Department immediately.

YES NO

2.ANTIBOYCOTT COMPLIANCE SCREEN: Has the customer discussed, either verbally or in writing, any of the boycott requests as described in the AntiBoycott Checklist located in Attachment A?

YES NO

3.DIVERSION RISK SCREEN: Is there a risk that the customer could be illegally diverting our products/services to a different country or to a different customer? To decide whether there is a risk of diversion, review the Diversion Risk Factors Checklist on Attachment A.

YES NO

4.NUCLEAR SCREEN: Do you know, or have reason to know, that the exported product will be used directly or indirectly in any nuclear activities? To decide whether you have such knowledge, fill out the Nuclear Checklist on Attachment A.

YES NO

  1. MISSILE SCREEN: Do you know, or have reason to know, that the exported product will be used directly or indirectly in any missile-related activities? To decide whether you have such knowledge, fill out the Missile Checklist on Attachment A.

YES NO

6.CHEMICAL & BIOLOGICAL WEAPONS SCREEN: Do you know, or have reason to know, that the exported product will be used directly or indirectly in the design, development, production, stockpiling, or use of chemical or biological weapons? To decide whether you have such knowledge, fill out the Chemical / Biological Checklist on Attachment A.

YES NO

CERTIFICATION PAGE

THE SALES REPRESENTATIVE OR INDIRECT SALES MANAGER LISTED BELOW HEREBY CERTIFY THAT TO THE BEST OF THEIR KNOWLEDGE THE CUSTOMER INFORMATION CONTAINED IN THIS PRESHIPMENT EXPANDED EXPORT SCREENING IS TRUE AND CORRECT.

SALES REPRESENTATIVE / INDIRECT SALES MANAGER
(For orders sold through Distributors/Resellers)
Signature / Signature
Printed Name / Printed Name
Date / Date
CONFIRMATION BY CUSTOMER SERVICE REPRESENTATIVE
THAT ALL INFORMATION REQUIRED IN THIS EES HAS
BEEN COMPLETED:
Signature / Date
Printed Name

FILING AND DISTRIBUTION INSTRUCTIONS FOR EES FORMS:

  • THE ORIGINALLY SIGNED EES FOR CUSTOMERS IN “ALL” COUNTRIES MUST BE MAINTAINED IN THE LOCAL COUNTRY OFFICES.
  • FOR ALL CUSTOMERS IN “HOT” COUNTRIES, PLEASE:
  1. EMAIL A COPY OF THE EES TO THE U.S.SIEMENS PLM SOLUTIONS EXPORT COMPLIANCE DEPARTMENT; AND
  2. FAX A COPY OF THE CERTIFICATION PAGE TO THE U.S.SIEMENS PLM SOLUTIONS EXPORT COMPLIANCE DEPARTMENT.
  • FOR ALL CUSTOMERS IN “NON-HOT” COUNTRIES WHO HAVE ANSWERED “YES” TO ANY QUESTIONS ON THE EES, PLEASE EMAIL A COPY OF THE EES TO THE U.S.SIEMENS PLM SOLUTIONS EXPORT COMPLIANCE DEPARTMENT.

1

Revision3.1 April 8, 2004

Customer Name:
Customer Number:
Country:
ATTACHMENT A

Preshipment Expanded Export Screening

August 2003 (Revised)

SIEMENS PLM Solutions Inc. (“SIEMENS PLM Solutions”) is committed to full compliance with all U.S. Export Laws and Regulations. One of the most effective means of ensuring compliance is to complete a Preshipment Expanded Export Screening. This will greatly reduce the risk of inadvertently exporting to an unauthorized party or for an unauthorized end-use. Special screening elements have been designed to provide a mechanism to help us evaluate our export transactions.

1) Denied Parties List Screen

2) AntiBoycott Compliance Screen

3) Diversion Risk Screen (Red Flags)

4) Nuclear Screen

5) Missile Screen

6) Chemical & Biological Weapons Screen

1) DENIED PARTIES LIST SCREEN

The U. S. Government prohibits relations with individuals, companies or organizations that have been denied export privileges. New and renewal business opportunities must be evaluated to determine if the customer and/or customer executives are found on the Denied Parties List. The List can be found on the on the Web at or contact the SIEMENS PLM Solutions Export Compliance Department for a copy of the List.

Violations can lead to the loss of SIEMENS PLM Solutions' export privileges, fines of up to $50,000, and imprisonment of not more than ten years.

Is the customer listed on the MK Technology Denied Parties List? If the customer is listed, then contact the SIEMENS PLM Solutions Export Compliance Department immediately.

YES NO

Procedure:

Screen each transaction against the most current Denied Parties List. This should be done before accepting an order.

Screening should be documented on the Customer Profile Expanded Export Screening Summary. Click on the “Yes” block of the Denied Parties List Screen if the customer is found on the Denied Parties List. Click on the “No” block of the Denied Parties Screening if the customer is not found on the List.

2)ANTIBOYCOTT COMPLIANCE SCREEN

The United States antiboycott laws prohibit U. S. Firms and their foreign operations from participating in foreign boycotts that the U. S. does not sanction. Prospective and current customers must be evaluated against the following list of boycott requests:

AntiBoycott Checklist

  • Agreements to refuse or actual refusals to do business with Israel or with blacklisted companies.
  • Agreements to discriminate or actual discrimination against other persons based on race, religion, sex, national origin or nationality.
  • Furnishing information about business relationships with Israel or with blacklisted companies.
  • Furnishing information about the race, religion, sex, or national origin of any person.
  • Paying, or otherwise implementing letters of credit that include requirements to take boycott related actions prohibited by the antiboycott regulations.

The Arab League boycott of Israel is the principal foreign economic boycott that U. S. companies must be concerned with today. The antiboycott laws, however, apply to all boycotts that are unsanctioned by the United States. Violations of the antiboycott provisions carry the same penalties as those for export control violations.

Has the prospective or current customer discussed, verbally or in writing, any of the above-listed boycott requests?

YES NO

If the answer is “Yes,” contact the SIEMENS PLM Solutions Export Compliance Department immediately.

Procedure:

Each transaction should be screened against the boycott requests listed above.

Screening should be documented on the Customer Profile Expanded Export Screening Summary. Click on the "Yes" block of the AntiBoycott Compliance Screen if you identified any risk factors and answered yes to the question above. Click on the "No" block if no risk factors are found.

3) DIVERSION RISK SCREEN (Red Flags)

Prospective and/or current customers must be evaluated against a "Diversion Risk Factors Checklist" to assure that they will not be illegally diverting our products/services to a different country or to a different customer.

Diversion Risk Factors Checklist:

  • The customer or its address is similar to one of the parties found on the MK Technology Denied Parties List.
  • The customer or purchasing agent is reluctant to offer information about the end-use of the item.
  • The product’s capabilities do not fit the buyer’s line of business, such as an order for sophisticated computers for a small bakery.
  • The item ordered is incompatible with the technical level of the country to which it is being shipped, such as semiconductor manufacturing equipment being shipped to a country that has no electronics industry.
  • The customer is willing to pay cash for a very expensive item when the terms of sale would normally call for financing.
  • The customer has little or no business background.
  • The customer is unfamiliar with the product’s performance characteristics but still wants the product.
  • Routine installation, training, or maintenance services are declined by the customer.
  • Delivery dates are vague, or deliveries are planned for out of the way destinations.
  • A freight forwarding firm is listed as the product’s final destination.
  • The shipping route is abnormal for the product and destination.
  • Packaging is inconsistent with the stated method of shipment or destination.
  • When questioned, the buyer is evasive and especially unclear about whether the purchased product is for domestic use, for export, or for re-export.

After reviewing the Diversion Risk Factors Checklist, is it known or are there any indications that the customer is at risk for diversion?

YES NO

If the answer is “Yes,” do not proceed with this transaction and contact the SIEMENS PLM Solutions Export Compliance Department immediately.

Procedure:

Screen each transaction against the Diversion Risk Factors Checklist (Red Flags).

Screening should be documented on the Customer Profile Expanded Export Screening Summary. Click on the “Yes” block of the Diversion Risk Screen if you identify any Diversion Risk Factors. Click on the “No” block of the Diversion Risk Screen if no risk factors are found.

4) NUCLEAR SCREEN

Answer the questions below, in sequence, to determine if the current and/or prospective customer is involved in sensitive nuclear transactions.

Level 1

Is the customer located in a country other than Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Turkey or the United Kingdom?

YES NO

- If yes proceed to Level 2. If the answer is no you may proceed to the Missile Screen (Item 5).

Level 2

Do you have knowledge that the customer is involved in any of the following potentially nuclear related industries or activities?

  • power plants YES NO
  • energy plants YES NO
  • separation of isotopes of any source or special nuclear materialYES NO
  • production of heavy waterYES NO
  • nuclear fuel fabricationYES NO
  • nuclear explosives or weapon activitiesYES NO
  • manufacturing of parts used in atomic facilities YES NO
  • nuclear or atomic reprocessing plants YES NO
  • nuclear or atomic waste activities YES NO
  • nuclear or atomic "source" material (e.g. plutonium/enriched uranium)

YES NO

  • plants of any kind supported by fast breeder reactors YES NO
  • institutes of science and technology YES NO
  • radiological facilities YES NO
  • conventional weapons and armaments research and development establishments

YES NO

  • other military entities YES NO

If the answer to any of these questions is “Yes,” proceed to Level 3, Nuclear Controls Checklist. If you answered “No” to these questions you may proceed to the Missile Screen (Item 5).

Level 3

Nuclear Controls Checklist

Do you have knowledge that the customer is directly or indirectly involved in any of the following activities:

  • Research on or designing, developing, fabricating, testing or maintenance of nuclear weapons or nuclear explosive devices or components or subsystems of such a device?

YES NO

  • Research on, or development, design, manufacture, construction, operation, or maintenance of:

a)a nuclear reactor

b)a critical facility

c)a facility for the fabrication of nuclear fuel

d)a facility for the conversion of nuclear material from one form to another

e)a storage installation

YES NO

  • Nuclear fuel cycle activities including research on development, design, manufacture, construction, operation, or maintenance of any of the following facilities or components for such facilities:

a) facilities for the chemical processing of irradiated special nuclear or source material?

b) facilities for the separation of isotopes of any source or special nuclear material?

c) facilities for the production of heavy water (deuterium)?

d) Facilities for the fabrication of nuclear reactor fuel containing plutonium?

YES NO

Procedure:

Screening should be documented on the Customer Profile Expanded Export Screening Summary. Click on the “Yes” block of the Nuclear Screen if you have answered yes to any of the questions in Level 2 or Level 3. Click on the “No” block of the Nuclear Screen if you have answered no to all of the questions in Level 2 and Level 3.

NOTE: Extra caution should be used in exporting items to institutes of science and technology, conventional weapons and armaments research and development establishments and other military entities.

5) MISSILE SCREEN

Answer the questions below, in sequence, to determine if the current and/or prospective customer is involved in transactions involving missiles*.

* The term “Missiles” is defined in the U. S. Export Regulations as “rocket systems (including ballistic missile systems, space launch vehicles, and sounding rockets) and unmanned air vehicles systems (including cruise missile systems, target drones, and reconnaissance drones) capable of delivering at least 500 kilogram pay-load to a range of at least 300 kilometers.”

Level 1:

Is the customer located in Bahrain, China, Egypt, India, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Libya, Macau, North Korea, Oman, Pakistan, Qatar, Saudi Arabia, Syria, United Arab Emirates or Yemen?

YES NO

- If “Yes,” proceed to Level 2. If the answer is “No” you may proceed to Chemical & Biological Weapons Screen (Item 6).

Level 2:

Do you have knowledge that the customer is involved in any of the following projects?

  • China - M Series Missiles, CSS-2
  • India - Agni, Prithvi, SLV-3, Satellite Launch Vehicle, Augmented Satellite Launch Vehicle

(ASLV), Polar satellite Launch Vehicle, (PSLV), Geostationary Satellite Launch vehicle

(GSLV).

  • Iran - Surface to Surface Missile Project, SCUD Development Project.
  • North Korea - No Dong I, SCUD Development Program
  • Pakistan - Haft Series Missiles

YES NO

If the answer is "Yes," contact the SIEMENS PLM Solutions Export Compliance Department. If the answer is "No," proceed to Level 3.

Level 3:

Is it known or are there indications that the customer is involved directly or indirectly in the design, development, production or use of missiles? YES NO

Do you have knowledge that the customer is involved in any activities involving the direct or indirect assistance in the design, fabrication, operation or maintenance of rocket systems (including ballistic missile systems, space launch vehicles and sounding rockets)?

YES NO

Do you have knowledge that the customer is involved in any activities involving the direct or indirect assistance in the design, fabrication, operation or maintenance of unmanned air vehicles systems (including cruise missile systems, target drones, remotely piloted vehicles and reconnaissance drones)?

YES NO

Do you have knowledge that the customer is involved in any activities involving the design, development or production of any parts, components or subsystems of missiles? (Missile is defined as “rocket systems (including ballistic missile systems, space launch vehicles, and sounding rockets) and unmanned air vehicles systems (including cruise missile systems, target drones, and reconnaissance drones).”) YES NO

If the answer to any of these questions is “Yes,” proceed to Level 4.

Level 4:

The customer is required to complete the “Customer Certification Letter” and “Addendum 1 - Missile Payload and Range Certification” and forward to the SIEMENS PLM Solutions Export Compliance Department.

Procedure:

Screening should be documented on the Customer Profile Expanded Export Screening Summary. Click on the “Yes” block of the Missile Screen if you have answered yes to any of the questions in Level 2 or Level 3. Click on the “No” block of the Missile Screen if you have answered no to all of the questions in Level 2 and Level 3.

6) CHEMICAL & BIOLOGICAL WEAPONS SCREEN

Answer the questions below, in sequence, to determine if the current and/or prospective customer is involved in transactions involving chemical and biological weapons.

Level 1:

Is the customer located in any of the following countries: Afghanistan, Armenia, Azerbaijan, Belarus, Bahrain, Bulgaria, China (PRC), Cuba, Egypt, Georgia, India, Iran, Iraq, Israel, Jordan, Kazakhstan, Kuwait, Kyrgystan, Lebanon, Libya, Macau, Moldova, Mongolia, Myuanmar (Burma), North Korea, Oman, Pakistan, Qatar, Russia, Saudi Arabia, Syria, Taiwan, Tajikistan, Turkmenistan, Ukraine, United Arab Emirates and Yemen, Uzbekistan and Vietnam?

YES NO

- If yes, proceed to Level 2.

Level 2:

Indicate if the customer is involved in any of the following chemical or biological activities or industries:

  • chemical plants YES NO
  • petrochemical plants YES NO
  • petroleum YES NO
  • cosmetics YES NO
  • food processing YES NO
  • glass, ceramic or porcelain production YES NO
  • mining operations YES NO
  • metal manufacturing YES NO
  • organic synthesis YES NO
  • paper manufacturing YES NO
  • plastic or rubber manufacturing YES NO
  • pharmaceuticals YES NO
  • textile or textile dyes YES NO
  • insecticides or pesticides YES NO
  • semiconductor manufacturing YES NO
  • paint production YES NO
  • institutes of science and technology YES NO
  • conventional weapons and armaments research and development establishments

YES NO

  • other military entities YES NO
  • other potential end-users of controlled chemical weapons precursors or biological

agents YES NO

- If any answer to any of these questions is “Yes,” proceed to Level 3, the CBW Profile Checklist.