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["**INTERN- Nicht an den Lieferanten versenden**"]
["Anforderungsprofil Lieferant"]
["Firmenname ",null,"Adresse ",null,null,"Name der Kontaktperson ",null,null,"Email Adresse "]
[]
["Zutreffenede Anforderungen auswählen: "]
["QM System ",null,"Bemerkung",null,"Technologie",null,"Bemerkung",null,"Mengen",null,"Bemerkung"]
[null,"ISO9001",null,null,null,"Optik",null,null,null,"1-10"]
[null,"ISO13485",null,null,null,"Mechanik",null,null,null,"11-100"]
[null,"Andere",null,null,null,"Elektronik",null,null,null,"101-500"]
[null,"Andere",null,null,null,"Software",null,null,null,"501-2.000"]
[null,"Andere",null,null,null,"Andere",null,null,null,"2.000-5.000"]
["Sonstige Punkte (Felder sind frei befüllbar) "]
["Anforderung",null,null,null,null,"Bemerkung"]
[]
[]
[]
[]
[]
[]
[]
["SCM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]

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["1.) General information"]
["Company name",null,null,null,null,"Turnover previous year"]
["Street",null,null,null,null,"Street number"]
["Postal code",null,null,null,null,"Ort"]
["Country",null,null,null,null,"Homepage"]
["Telephone",null,null,"Fax",null,null,"E-Mail"]
[]
[]
["2.) Company profile"]
["Legal form",null,null,null,null,"Founding year"]
["Corporate affiliation",null,null,null,null,"Subsidiaries"]
[]
[]
["3.) Contact person"]
["General manager"]
["Name",null,null,null,null,"E-Mail"]
["Telephone number",null,null,null,null,"Fax"]
[]
["Sales manager"]
["Name",null,null,null,null,"E-Mail"]
["Telephone number",null,null,null,null,"Fax"]
[]
["Quality Manager "]
["Name",null,null,null,null,"E-Mail"]
["Telephone number",null,null,null,null,"Fax"]
[]
[]
["4.) Quality management"]
["Certificates"]
["Standard ",null,null,null,"valid until",null,"Certification Body "]
["Standard ",null,null,null,"valid until",null,"Certification Body "]
["Standard ",null,null,null,"valid until",null,"Certification Body "]
[]
["Do you calibrate your measuring devices?",null,null,null,null,"If so, from which organization:"]
[]
["5.) IT-Equipment"]
["ERP-System"]
["CAD-Systems"]
["Name",null,null,null,"Version"]
["Name",null,null,null,"Version"]
["Name",null,null,null,"Version"]
["Name",null,null,null,"Version"]
[]
[]
["6.) Number of employees"]
["Production",null,null,"Assembly",null,"Development",null,null,"Administration \n(white collar)"]
["Quality",null,null,"Complete"]
[]
[]
["7.) Performance paramter"]
["Production",null,null,"Production hours/Year - Production"]
[null,null,null,"Production hours/Year - Assembly"]
["Shift plan"]
[]
[]
[]
[]
[]
["8.) Technology Optic"]
["Optical metrology",null,null,null,"Tick the relevant box"]
["Optical systems"]
["Optical simulation"]
["Freeform surface design/production"]
["Laser technology"]
["Plano optics"]
["Spherical optics"]
["Aspherical optics"]
["Filter "]
["Coating"]
["Assembly"]
["Other"]
["Other"]
["Other"]
[]
[]
["9.) Technology Mechanic"]
["Machining production (turn, mill, etc.)",null,null,null,"Tick the relevant box"]
["Drive engineering"]
["Simulation"]
["Generally system design"]
["Metal-Casting design/production"]
["Plastic injection moulding design/productin"]
["Sheet metal design/production"]
["Chassis design/production"]
["Prototyping mechanical"]
["Generative manufacture Design"]
["Functional surfaces"]
["Temper"]
["Other"]
["Other"]
["Other"]
[]
[]
["10.) Technology Electronic"]
["PBC Layout and Rapid Prototyping",null,null,null,"Tick the relevant box"]
["(Embedded) PC Systems and Monitors"]
["Development circuit technology analogue HF power"]
["Development circuit technology digital bus systems"]
["Prototyping electronic"]
["Cabel assembly"]
["PCB assembly"]
["Other"]
["Other"]
[]
["11.) Technology Software"]
["Application software",null,null,null,"Tick the relevant box"]
["Firmware"]
["Software as medical product"]
["Imaging"]
["Other"]
["Other"]
["Other"]
[]
["12.) Technology Other"]
["Automation engineering",null,null,null,"Tick the relevant box"]
["Adhesive tochnology"]
["Packaging technology"]
["Surface treatment Lacquering/coating"]
["Surface treatment electroplating"]
["Other"]
["Other"]
["Other"]
[]
["13.) Documents"]
["Which documents are attached to this SSA:"]
["Company folder"]
["Company overview"]
["QM-certificates"]
["Annual report"]
["List of machinery"]
["Reference list"]
[]
[]
["14.) Additional information (please decribe your core competences and preferred manufacturing lot sizes in more detail)"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["This supplier self-assement is an  important part for the supplier qualifcation process. All prodived information will be treated confidentially. \nData contained in this form is processed and stored by WILD for the purpose of supplier qualification. Data will not be passed on to third parties. By submitting this file you agree to the electronic processing and storage of provided data."]
[]
[]
[]
[]
[]
["Date:",null,null,null,null,null,"Signature:"]

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["**INTERN- Nicht an den Lieferanten versenden**"]
["Firmenname ",null,"Adresse ",null,null,"Name der Kontaktperson ",null,null,"Email Adresse "]
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["15.) Bewertung"]
["Erfüllungsgrad Anforderungsprofil"]
[]
[]
[]
["SCM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
[]
["16.) Risikobewertung"]
["Risikobewertung gmäß SCM-001"]
[]
[]
[]
[]
["QM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
["SCM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
["17.) Verträge "]
["Vertäge bei niedrigem Risiko",null,null,null,"Verträge bei mittlerem und hohem Risiko"]
[]
[]
["Vertrag von beiden Vertragsparteien unterzeichnet und im ERP System archiviert."]
["SCM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
["18.) Audit (Nur relevant bei Baugruppenlieferanten oder bei spezieller Kundenanfordernung) "]
[]
[]
[]
[]
["QM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
["19.) Verifikation der Musterteile "]
["Artikelnummer: ",null,null,null,"Bestellnummer",null,null,"sonstiges"]
[]
[]
[null,null,null,null,null,null,null," "]
[]
[]
[]
["SCM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
[]
["20.) Lieferantenfreigabe"]
["Formale Lieferantenfreigabe durch Leitung SCM  und Leitung QM"]
[null,null,null,null,null,null,null,null,"Lieferantennummer"]
[]
[]
["QM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]
[]
["SCM: Vorname, Nachname ",null,null,null,"Datum ",null,null,"Unterschrift: "]