Supplier self-declaration

1. Postal address

Company name

Street

House number

Post code

City

Country

Telephone

Fax

Website

2. Company management/contact person

Departments

Name

Telephone

Company management

Plant management

Quality assurance

Sales management*

Internal sales*

Field sales*

Shipping

Accounting

3. Company figures

Is the company part of a group?

YES

Group name

Number of employees

company

Group

Annual revenue

company

Group

Does the company have product liability insurance?*

YES

Sum insured*

4. Quality management

Do you have a certified quality management system?*

YES

IN PROGRESS

If yes, which system(s)? (Please attach certificates)

Certificates

Delete

Additional certificate +

5. CSR

Is there an employee at your company who is responsible for sustainable business, as it relates to social, ecological and economical aspects?

YES

Name of the responsible employee

Does your company have formal guidelines regarding working conditions and human rights?

YES

If yes, please attach documents.

Delete

Additional document +

Does your company have a responsible or sustainable procurement policy?

YES

If yes, please attach documents.

Delete

Additional document +

Does your company record environmental data?

YES

Does your company publish a sustainability report?

YES

If yes, please attach documents.

Delete

Additional document +

6. REACH

1. For the supplied products, we require a declaration in accordance with the latest REACH list of substances of very high concern (SVHC). Please inform us of any SVHCs contained in products, which exceed the limit of 0.1 % w/w in accordance with (EG) 1907/2006.

Yes, we have read and accept the conditions.

2. For the supplied products, we require a declaration in accordance with the latest RoHS substance list (if applicable). Please inform us if your products contain any of the six original hazardous substances listed in Directive 2011/65/EU and all current changes, as well as any possible exceptions.

Yes, we have read and accept the conditions.

7. Accounting

Bank details*

Bank name*

IBAN*

BIC*

VAT ID*

8. Products/product groups/services

You would like to offer the following products/product groups/services:

9. Submit

The signatory guarantees that the information provided is correct.

Date*

Name*

Title*

10. anti-spam protection

Please solve the following calculation:

two + two =