Supplier's Declaration of Conformity

for Material Declaration Management

1) SDoC No.: A0527.01

2) Issuer’s name: Siemens AG

Issuer’s address: Werner-von-Siemens-Str. 48
92224 Amberg, Germany

3) Object of declaration: Confirmation A0434.04

4) The object of the declaration described above is in conformity with the

following documents

5) Applicable Regulations or other stipulated requirements and documents

Document No.: Title: Edition Date of issue
Guidelines for the Development of Inventory of
MEPC. Res 269(68) 2015
Hazardous Materials
International Hong Kong Convention for the Safe
SR CONF 45 2009
and Environmentally Sound Recycling of Ships

Ships and marine technology - Ship recycling

management systems - Information control for
ISO 30005 2010
hazardous materials in the manufacturing chain of
shipbuilding and ship operations

Regulation of the European Parliament and of the

REGULATION (EU) Council of 20 November 2013 on ship recycling
No 1257/2013 and amending Regulation (EC) No 1013/2006 and
2013
Directive 2009/16/EC

related to:
EMSA's Best Practice Guidance on the Inventory
REGULATION (EU) 2016
of Hazardous Materials
No 1257/2013

6) Additional Information： none

Signed for and on behalf of: Siemens Aktiengesellschaft

Amberg
Place of issue
2022-12-07
Date of issue
Heitzer Digital signiert von Heitzer Alois
DN: cn=Heitzer Alois, o=Siemens,
email=alois.heitzer@siemens.com

7) i.V. Alois Heitzer Alois Datum: 2022.12.09 17:43:38

+01'00'

Head of Supplier Quality & Technology and Material Coordination Signature

Meier Digital signiert von Meier Markus
DN: cn=Meier Markus, o=Siemens,
email=markus.meier@siemens.com

i.V. Markus Meier Markus Datum: 2022.12.12 09:17:41 +01'00'

Head of R&D Control Products Signature

 Confirmation A0434.04

Product identification: 3RA, 3RB, 3RE, 3RF, 3RG, 3RH, 3RK, 3RM, 3RN, 3RP, 3RQ,
3RR, 3RS, 3RT, 3RU, 3RV, 3RW, 3RX, 3SB, 3SE, 3SF, 3SK,
3SU, 3SX, 3TB, 3TC, 3TD, 3TS, 3TE, 3TF, 3TG, 3TH, 3TK,
3TX, 3TY, 3UA, 3UF, 3UG, 3UL, 3US, 3UX, 3MH, 3MT, 3MU,
3MV, 3VU, 3VS, 3ZY, 4AM, 4AP, 4AT, 4AU, 4AV, 4EP, 4EU,
5TT, 6GK, 7PV, 8US, 8WD, 8WN, 8WU, 7UG, LZS, LZX
Manufacturer: Siemens AG, SI EP
Address: Gerätewerk Amberg, Werner-von-Siemens-Str. 48, 92224 Amberg,
_ Germany

SDOC ID-No.: A0527.01

Material Declaration “Green Passport”

This form is based on IMO Resolution MEPC. 269(68) Inventory of Hazardous Materials (Green Passport)

Product Name Delivered Unit Product Information

amount Unit

see above 1 piece RoHS compliant; Pb might appear as defined in the exemp-
tions of Annex III and IV of the EU Directive 2011/65/EU

Siemens Aktiengesellschaft

Amberg, 2022-12-07

Material Information:

The content of this confirmation is intended to supplement the technical information on the products concerned in the corresponding product description or to confirm
their validity once again. Further commitments or legal consequences cannot be derived from this confirmation.
Siemens Aktiengesellschaft: Chairman of the Supervisory Board: Jim Hagemann Snabe;
Managing Board: Roland Busch, Chairman, President and Chief Executive Officer; Cedrik Neike, Matthias Rebellius, Ralf P. Thomas, Judith Wiese
Registered offices: Berlin and Munich, Germany; Commercial registries: Berlin-Charlottenburg, HRB 12300, Munich, HRB 6684
WEEE-Reg.-No. DE 23691322

SCF V12 Page 1 of 2

 A0434.04

This material information shows the amount of hazardous material contained in (unit: piece, kg, m, m2, m3, etc) of the product.

Present above If yes, If yes,

Table Material Name Threshold threshold level Material Mass Information of Parts/Region of Use
Level Yes / No Mass Unit
Asbestos No
0.1 %*

Polychlorina- Polychlorinated Biphenyls (PCBs) No

ted Biphe- 50 mg/kg
nyls (PCBs)
No
Chlorofluorocarbons (CFCs)
Table A**
(Materials Halons No
listed in ap-
pendix 1 of Other fully halogenated CFCs No
the Conven- Carbon tetrachloride No
tion) Ozone
No threshold
Depleting 1,1,1- Trichloroethane No
level
Substance
Hydrochlorofluorocarbons No

Hydrobromofluorocarbons No

Methyl bromide No

Bromochloromethane No

Anti-fouling systems containing organotin com-

pounds as a biocide 2500 mg/kg No

Intentionally If yes,
Table Material Name Threshold added above If yes, Information of Parts/Region of Use
Level threshold level Material Mass
Yes / No Mass Unit
Cadmium and cadmium compounds 100 mg/kg No

Hexavalent chromium and hexavalent chromium No

1000 mg/kg
Table B** compounds
(Materials Lead and lead compounds Yes PCHM*****; can only be present in exemp-
listed in appen- tions as defined in MEPC 269(68) point
1000 mg/kg
dix 2 of the 3.3.- "Exemptions – Materials not required
Convention) to be listed in the Inventory"
Mercury and mercury compound 1000 mg/kg No

Polybrominated biphenyl (PBBs) 1000 mg/kg No

Polybrominated dephenyl ethers (PDBEs) 1000 mg/kg No

Polychloronaphthalanes (Cl=>3) No threshold No

level
Radioactive Substances No threshold No
level
Certain shortchain chlorinated paraffins 1% No

Annex II*** Perfluorooctane sulfonic acid (PFOS) 10 mg/kg**** No

(Additional Ma-
terials) Flame Retardant (HBCDD) 100 mg/kg No

*Please refer to footnote 18 on the "Form of Material Declaration" in the IMO Guidelines Resolution MEPC.269(68).
**Hong Kong International Convention for the Safe and Environmentally Sound Recycling of Ships, 2009 (SR/CONF/45).
***Regulation EU No. 1257/2013 of the European Parliament and of the Council of 20 November 2013 on Ship Recycling and amendi ng Regulation EC No. 1013/2006 and Directive
2009/16/EC EMSA's Best Practice Guidance on the Inventory of Hazardous Materials, dated 2016-10-28
****Concentrations of PFOS above 10 mg/kg (0.001% by weight) when it occurs in substances or in preparations or concentrations of PFOS in semi-finished products or articles, or parts
thereof equal to or above than 0.1% by weight calculated reference to the mass of structurally or micro-structurally distinct parts that contain PFOS or for textiles or other coated materials, if the
amount of PFOS is equal to or above than 1 μg/m² of the coated material
***** Potentially Containing Hazardous Substances

The content of this confirmation is intended to supplement the technical information on the products concerned in the corresponding product description or to confirm
their validity once again. Further commitments or legal consequences cannot be derived from this confirmation.
Siemens Aktiengesellschaft: Chairman of the Supervisory Board: Jim Hagemann Snabe;
Managing Board: Roland Busch, Chairman, President and Chief Executive Officer; Cedrik Neike, Matthias Rebellius, Ralf P. Thomas, Judith Wiese
Registered offices: Berlin and Munich, Germany; Commercial registries: Berlin-Charlottenburg, HRB 12300, Munich, HRB 6684
WEEE-Reg.-No. DE 23691322
SCF V12 Page 2 of 2