* indicates required data
Legal Name of Company (as reported to IRS)
*
The supplier represents and certifies that it is a:
Business Size *
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Business Type *
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Business Activity *
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Business Category
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(Check one)
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(Check one)
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(Check one)
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(Check all that apply)
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Large
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Small
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Small
Disadvantaged
(definitions)
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Corporation
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Partnership
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Sole
Proprietor
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Individual
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Trust/Estate
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Government
Agency
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LLC
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Real Estate Rental/Lease
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Equipment Rental/Lease
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Medical/Health Care
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Merchandise (goods only)
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Merchandise Services
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Legal Firm/Attorney/Lawyer
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Royalties
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Service Only
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Consultant/Professional Fees
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Donation/Charitable Contribution
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Woman
Owned
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Manufacturer
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Distributor
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Non-Profit
Organization
(definitions)
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Company Full Time Staff (not contractor) size: *
Including yourself, does the sole proprietorship, LLC, C Corporation, S Corporation, partnership or third party have a total of 7 or more (a) other partners, members, shareholders, or stockholders and/or (b) W-2 employees?
For example, if you own an LLC and have 6 employees employed by the LLC, then the answer is "Yes". For example, if you have a partnership and only have 1 other partner but no other employees, then the answer is "No".
< 6 people
> 6 people
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Business Classification -
Certification Requirement:
Proof of third party certification is required in order for a business entity to be classified as a minority (MBE) or woman-owned (WBE) supplier in the Texas Instruments database. You must confirm your MBE or WBE status with a certification number and expiration date for one of the agencies listed below. If the agency that provided your MBE or WBE certification is not listed, please enter the certification number, expiration date and agency name in the space denoted as "Other".
Click
here for Texas Instruments
Supplier Diversity requirements.
The supplier represents that its qualifying ownership falls within at least one of the following categories.ne of the following categories.
Minority Business Representation *
Asia-Pacific American
- U.S. Citizen with origins from Japan, China, the Philippines, Vietnam, Korea, Samoa, Guam, the U.S. Trust Territory of the Pacific Islands (Republic of Palau), the Northern Mariana Islands, Laos, Kampuchea (Cambodia), Taiwan, Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Republic of the Marshall Islands, or the Federated States of Micronesia, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru
Black American - U.S. Citizen
Combined Ethnic group Ownership - Two or more minority groups
Hispanic American
- U.S. Citizen with origins from South America, Central America, Mexico, Cuba, the Dominican Republic, Puerto Rico, Spain, or Portugal
Historical Black College and University/Minority Institute
Individual/concern
currently certified for participation in the Minority Small Business and Capital Ownership Development Program under section 8(a) of the Small Business Act (15 U.S.C. 637(a))
Native American
- American Indians, Eskimos, Aleuts, or Native Hawaiians, including Indian tribes or native Hawaiian organizations
Subcontinent Asian (Asian-Indian American)
- U.S. Citizen with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal
None of the above
Required Tax Documentation Required Tax Documentation
In accordance with TI practice and policies, prior to initial payment, Payee will provide TI with valid US tax documentation declaring status of beneficial owner of any income generated by the requested payment. Please review A, B, and C below and respond accordingly.
A. If Payee is a US resident, corporation, or otherwise beneficially owned by a US entity:
- Payee must provide a valid (authorized signature required), US Form W-9 (or other appropriate US tax declaration form) (W-9, Instructions) and submit to TI via email at simthelp@ti.com
Email
(Preferred method) |
Mail
(Use this option only if you don't have
access to Email) |
simthelp@ti.com |
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Texas Instruments
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Supplier Information Management
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US Tax Declaration
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13570 N Central Expwy
MS
3913
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Dallas, Texas 75243
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B. If Payee is a non-US or foreign resident, corporation, or otherwise beneficially owned by a non-US or foreign entity (choose from the taxpayer type that best fits your situation):
* A partnership may substitute its own form for the official version of Form W-8 to ascertain the identity of its partners.
** A domestic grantor trust must provide a statement as shown in Sec. 1.1446-1(c)(2)(ii)(e) and documentation for its grantor.
C. If TI is licensing intellectual property (IP) rights from your company AND that IP is registered in Germany, TI may be required to withhold on payments made to your company regardless of whether your company has any tax connection to Germany. Please answer the below questions to determine if this withholding applies. If you have any questions, please email german_royalty_compliance@list.ti.com
- Is TI licensing intellectual property (IP) rights from your company? If yes, proceed to (2). If no, please notify TI accordingly at german_royalty_compliance@list.ti.com and no further action is required.
- Is the IP right in question registered in a German public register (e.g., with the German Patent and Trademark Office)? If yes, proceed to (3). If no, please notify TI accordingly at german_royalty_compliance@list.ti.com and no further action is required.
- Please provide a properly issued certificate of exemption that indicates the applicable tax treaty providing relief from German withholding. If you do not have a certificate of exemption, please email german_royalty_compliance@list.ti.com.
Additional Questions *
If yes (current/former employees, and close family domestic relationships of current employees), please give Names and Employment dates.
Special Instructions
I certify under penalty of perjury that the Tax Identification Number I have provided is correct
Please verify your information before clicking the submit button.
Please remember to send the appropriate Tax document (W8 or W-9 form).
The Legal Name submitted on this form should match the name on the Company Name on the Tax document.
TEXAS INSTRUMENTS INCORPORATED
* SUPPLIER INFORMATION MANAGEMENT
P O BOX 650311
* M/S 3913
* DALLAS TX 75265-0311
email:
simthelp@ti.com
20081117