RAW MATERIAL SUPPLIER QUESTIONNAIRE

Transcription

1 RAW MATERIAL SUPPLIER QUESTIONNAIRE Suppliers are requested to provide the information below to ensure that the operations of Covestro are in compliance with chemical regulatory requirements and the needs of our customers. Please send the completed form including a current copy of a regional valid Safety Data Sheet (SDS) and further attachments as appropriate back to the Procurement contact. 1. General information (MANDATORY) Product Trade Name CAS Number (if applicable) Supplier Name Supplier Address Manufacturing Country or Countries

2 2. Registration Information (MANDATORY) Country/Region-Registration information Yes No 2.1 Australia AICS - Australian Inventory of Chemical Substances Canada DSL/NDSL - Domestic Substances List/Non-Domestic Substances list China IECSC - Inventory of Existing Chemical Substances in China EU REACh (EU) pre- or registered? REACh-Registration number? Remark: If No, list exempt reason or new chemical Reg info.(cas No. or name, Reg type & volume) If Yes: Year of (intended) registration: Please also attach your REACh Compliance Statement to your answer. Strictly Controlled Conditions (SCC): Do you intend to register according to REACH Article 18 (4)? If you are not located in EEA, are you going to appoint an Only Representative (OR)? 2.5 Japan Listed on the Japanese Inventory (ENCS)? New NZIoC - New Zealand Inventory of Chemicals? Zealand Philippines PICCS - Philippine Inventory of Chemicals and Chemical Substances South KECL - Korean Existing Chemicals List Korea Are Phase I priority existing chemical substances (PECs) included in the product? List_of_existing_ chemical_substance 2.9 Switzerland Are all components of this material (except impurities and adjuvants) either listed on the EINECS Inventory, or the No-Longer-Polymer (NLP)-List, or are Polymers, whose monomers are all listed on the Taiwan EINECS Inventory? TCSI - Taiwan Chemical Substance Inventory If Yes, attach the contact data of your Only Representative. If No, attach the details of your chemical composition indicated above. If Yes, attach the details of letter of confirmation (Loc).

3 2.1 1 USA Have all existing chemical substances in the product been Phase I registered? TSCA US Inventory of Chemicals If Yes, list Reg number. 3. Existing substance registration information for Europe (NEEDS ONLY BE FILLED IN CASE SUPPLYING TO EUROPE) Requirements Yes No Remark: 3.1 Animal or plant products 3.2 Nanomaterials Is this product derived from or does it contain any animal or plant products? Does this product contain any Nanomaterials? If Yes, list component(s) and amount. If No, exclude questions If Yes, list national registry numbers

4 4. International Conventions status (MANDATORY) International convention 4.1 Montreal Protocol 4.2 Rotterdam Convention (PIC) 4.3 Stockholm Convention 4.4 Chemical Weapons Convention 4.5 Convention on Narcotic drugs and Psychotropic substances Controlled substance(s) included? Yes No Ozone Depleting Substances Hazardous Chemicals and Pesticides d/1132/language/en-us/default.aspx Persistent Organic Pollutants (POPs) Chemical Weapons Yellow List-List of Narcotic Drugs under International Control Green List-List of Psychotropic Substances under International Control Red List - List of Chemicals frequently used in the Illicit Manufacture of Narcotic Drugs and Psychotropic Substances under International Control Remark: If Yes, list controlled substance(s) & percentage

5 5. Information on special topics (NEEDS ONLY BE FILLED ON SPECIAL REQUEST ) Are all components of your product in compliance with : Yes No Remark: Provide statement 5.1 Food regulation 21 CFR of the U.S. Food and Drug Administration (FDA)? 5.2 EU Commission Regulation (EC) No. 10/2011? 5.3 Swiss Ordinance on Food Contact Materials and Articles (SR )? 5.4 Chinese Hygiene Standard GB ? Does your product contain any of the following? Yes No 5.5 Substances on the Global Automotive Declarable Substance List (GADSL) Lead, Mercury, Cadmium, Hexavalent chromium, Polybrominated biphenyls (PBB), Polybrominated diphenyl ethers (PBDE) 5.7 Organostannic compounds 5.8 Phthalates : Di(2-ethylhexyl) phthalate (DEHP), Di-n-butyl phthalate (DBP), Benzyl-n-butyl phthalate (BBP), Diisononyl phthalate (DINP), Diisodecyl phthalate (DIDP), Di-n-octyl phthalate (DnOP) 5.9 Polycyclic-aromatic hydrocarbons (PAH): Benzo[a]pyrene (BaP), Benzo[e]pyrene (BeP), Benzo[a]anthracene (BaA), Chrysen (CHR), Benzo[b]fluoranthene (BbFA), Benzo[j]fluoranthene (BjFA), Benzo[k]fluoranthene (BkFA), Dibenzo[a,h]anthracene (DBAhA) 5.10 Btex: Benzene, Toluene, Ethylbenzene, Xylene 5.11 Treatment process against Transmissible Spongiform Encephalopathies (TSE) like Bovine Spongiform Encephalopathy (BSE)? 5.12 Primary aromatic amines 5.13 Metals (EU Toy regulation, covering also packaging) 5.14 Food allergens according to EU directive 2003/89/EC 5.15 Genetically modified organisms (GMO) 5.16 Milk products 5.17 Natural latex 5.18 Palm oil 5.19 Jatropha 5.20 Substances classified as Carcinogenic, Mutagenic, Reprotoxic Under the Global Harmonized System (GHS) Remark: Provide statement or list restricted substance(s) & percentage

6 6. Replied by Name Title Tel address Fax 7. Supplier Declaration We confirm that the information in this questionnaire is true and complete and our product comply with revelent applicable regulatory requirements. Signature Company seal Date For any question, please contact : For Asia Pacific : productsafetyapac@covestro.com Phone Number: Product Safety & Regulatory Affairs 11/F, Citigroup Tower 33 Huayuan Shiqiao Road, Pudong Shanghai P.R. China For Europe: raw-material-management@covestro.com Covestro Deutschland AG COV-IO-S&A-PSRA-PSI B211, Leverkusen Germany