This document is a declaration of the substances within the manufacturer listed item.

Note: if the item is an assembly

Material Composition Declaration with lower level parts, the declaration encompasses all lower level materials for which the manufacturer has
© Copyright 2005. IPC, Bannockburn, Illinois. All rights reserved under engineering responsibility.
both international and Pan-American copyright conventions. Adobe Reader version 7.0.5 is required to complete this declaration.

IPC Web Site for Information on IPC-1752 Standard Form Type * Declaration Class *
1752-1 1.1
http://www.ipc.org/IPC-175x Distribute Class 3 - RoHS Yes/No, JIG Format Substances

Supplier Information
Company Name * Company Unique ID Unique ID Authority Response Date * Response Document ID
HMS Industrial Networks 556529-9251 Swedish Organistion Number 2009-04-14
Contact Name * Title - Contact Phone - Contact * Email - Contact *
Niklas Andersson Quality Engineer 00 46 35 17 29 52 [email protected]
Authorized Representative * Title - Representative Phone - Representative * Email - Representative * Supplier Comments or URL for Additional Information
Katarina Lekander Quality Mananger 00 46 35 17 29 11 [email protected] http://www.hms.se/company/environment.shtml
Requester Item Number Mfr Item Number Mfr Item Name Effective Date Version Manufacturing Site Weight * UOM Unit Type
AB4005-C ABS-PDP-4 2009-04-14 1 HMS Supply 31.2 g Each
Alternate Recommendation Alternate Item Comments

Manufacturing Information section intentionally omitted.

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RoHS Material Composition Declaration Declaration Type * Custom

RoHS Directive RoHS Definition: Quantity limit of 0.1% by mass (1000 PPM) in homogeneous material for: Lead (Pb), Mercury, Hexavalent Chromium, Polybrominated Biphenyls (PBB),
2002/95/EC Polybrominated Diphenyl Ethers (PBDE) and quantity limit of 0.01% by mass (100 PPM) of homogeneous material for Cadmium
RoHS Material declaration certificate: HMS Industrial Networks hereby states that its products when ordered as leadfree do not contain any of the restricted material as defined in the European Union directive 2002/95/EC in any amounts higher than limits
stated in the directive*.
Component qualification: Before each HMS product was released for RoHS, every component was examined and qualified for RoHS after gathering information from each respective manufacturer.
Lead free process: HMS RoHS products are manufactured in lead free processes. For more information regarding soldering temperature limits, or solder material and flux used during the lead free process, please contact HMS.
Identification: A RoHS product is marked RoHS label at product label, bag label and on over pack.

* This statement is based on information and data provided from 3rd parties and may not have been
verified through destructive testing methods or other chemical analysis.
HMS reserves the right to change the information stated in this document without any further notice

RoHS Declaration * 1 - Item(s) does not contain RoHS restricted substances per the definition above Supplier Acceptance * Accepted
Exemptions: If the declared item does not contain RoHS restricted substances per the definition above except for defined RoHS exemptions, then select the corresponding response in the RoHS Declaration
above and choose all applicable exemptions.

Declaration Signature
Instructions: Complete all of the required fields on all pages of this form. Select the "Accepted" on the Supplier Acceptance drop-down. This will display the signature area. Digitally sign
the declaration (if required by the Requester) and click on Submit Form to have the form returned to the Requester.
Elektroniskt undertecknad av Niklas Andersson

Supplier Digital Signature Niklas Andersson SN: cn=Niklas Andersson, o=HMS Industrial Networks AB, ou=Quality,
[email protected], c=SE
Datum: 2009.05.27 13:59:04 +02'00'

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Joint Industry Guide (JIG) Material Composition Declaration for Electronic Products
Instructions: Declare whether the item substances exceed the threshold levels shown in the table and report accordingly. Where threshold levels include the words "intentionally added",
substances must be declared if they are added intentionally, regardless of threshold level. For each RoHS substance, identified with dual asterisks (**), report the worst case PPM at the
homogeneous material level and optionally the total weight of the substance in the item. For all remaining (non-RoHS) JIG A & B substances, and any additional substances, report the total
weight and optionally the PPM at the part level for each item.

JIG A autofill - No JIG B autofill - No All autofill - No

Above
If yes, enter total weight and
JIG Category Name Threshold Level Threshold Description of Use
worse case PPM
Level?
Level As defined in the Joint Industry Guide Intentionally added or PPM Yes/No Weight UoM PPM
A Asbestos Intentionally Added No
A Certain Azo colorants Intentionally Added No
A Cadmium/Cadmium Compounds ** 75 PPM or Intentionally Added No
A Hexavalent Chromium/Hexavalent Chromium Compounds ** 1000 PPM or Intentionally Added No
A Lead/Lead Compounds ** 1000 PPM or Intentionally Added No
A Lead/Lead Compounds - PVC Cables and Wires Only ** 300 PPM No
A Mercury/Mercury Compounds ** 1000 PPM or Intentionally Added No
A Ozone Depleting Substances - Class I (CFCs, HBFCs, etc.) Intentionally Added No
A Ozone Depleting Substances - Class II (HCFCs) 1000 PPM No
A Polybrominated Biphenyls (PBBs) ** 1000 PPM or Intentionally Added No
A Polybrominated Diphenylethers (PBDEs) ** 1000 PPM or Intentionally Added No
A Polychlorinated Biphenyls (PCBs) Intentionally Added No
A Polychlorinated Naphthalenes ( > 3 chlorine atoms) Intentionally Added No
A Radioactive Substances Intentionally Added No
A Certain Shortchain Chlorinated Paraffins Intentionally Added No
A Tributyl Tin (TBT) and Triphenyl Tin (TPT) Intentionally Added No
A Tributyl Tin Oxide (TBTO) Intentionally Added No
B Antimony/Antimony Compounds 1000 PPM No
B Arsenic/Arsenic Compounds 1000 PPM No
B Beryllium/Beryllium Compounds 1000 PPM No
B Bismuth/Bismuth Compounds 1000 PPM No
B Brominated Flame Retardants (other than PBBs or PBDEs) 1000 PPM No
B Nickel (external applications only) 1000 PPM No
B Certain Phthalates 1000 PPM No
B Selenium/Selenium Compounds 1000 PPM No
B Polyvinyl Chloride (PVC) 1000 PPM No
Other Chloroparaffines 63449-39-8 1000 PPM No
Other Chloroparaffines 85535-84-8 1000 PPM No
Other Chloroparaffines 85535-85-9 1000 PPM No
Other Polybrominated Terphenyls ( PBT ) 1000 PPM No
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Other Polychlorinated Biphenyls ( PCB ) 1336-36-3 1000 PPM No
Other Polychlorinated Terphenyls ( PCT ) 61788-33-8 1000 PPM No
Other Thallium or its compounds 7440-28-0 1000 PPM No
Other Heavy metals or their compounds as pigments in paints or enamels 1000 PPM No
Other Polybrominated Diphenylethers (PBDE) 1163-19-5 1000 PPM No
Other PFOS or its compounds 50 PPM No
Other Di-(2-ethyl)hexylphthalate DEHP 117-81-7 1000 PPM No
Other n-dioctylftalat (DOP) 117-84-0 1000 PPM No
Other Diisononylphtalat 28553-12-0 1000 PPM No
Other Diisobuthylphtalat 84-69-5 1000 PPM No
Other Dibutylphthalate (DBP) 84-74-2 1000 PPM No
Other Buthylbensylphtalat 85-68-7 1000 PPM No

OTHER Material Composition Declaration

Requester Instructions: The requester can optionally include additional substances that must be declared for the item on this form. This is in addtion to JIG Level A and JIG Level B
substances. The requester should enter additional substances as well as the threshold levels that specify the substance at the item level.

Supplier Instructions: Explicitly declare whether the item exceed the threshold level by selecting Yes or No. If the maximum concentration of any substance exceeds the threshold levels
defined by the requester, then the substance content must be reported in total weight and/or worst case PPM, along with a description of material use.

JIG Category Name Threshold Level

Other As defined by the Supplier Defined by the Supplier

+ -
Add Other Material Composition to JIG Tab Clear Other Material Composition in JIG Tab

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