无冲突金属报告范本EICC Ge SIDDtemplate-rev 2.03a

无冲突金属报告范本

Conflict Minerals Reporting TemplateSelect Language Preference Here: 请选择你的语言 : : 表示言語をここから選択してください : Sé lectionner la langue pré fé ré e ici: Selecione Preferê ncia de idioma Aqui: Wä hlen sie hier die Sprache: Seleccione el lenguaje de preferencia aqui: Selezionare la lingua di preferenza qui:

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Revision 2.03a July 25th, 2013

The purpose of this document is to collect sourcing information on tin, tantalum, tungsten and gold used in products

Link to Terms & Conditions

Mandatory fields are noted with an asterisk (*). The information collected in this template should be updated annually. Any changes within the annual cycle should be provided to your customers Company Information Company Name (*): Declaration Scope (*): Description of Scope: Company Unique Identifier: Address: Authorized Company Representative Name (*): Representative Title: Representative Email (*): Representative Phone: Date of Completion (*): Answer the following questions 1 - 6 based on the declaration scope indicated above 1) Are any of the following metals necessary to the functionality or production of your company's products that it manufactures or contracts to manufacture? (*) Tantalum (*) Tin (*) Gold (*) Tungsten (*) 2) Do the following metals (necessary to the functionality or production of your company's products) originate from the DRC or an adjoining country? (*) Tantalum (*) Tin (*) Gold (*) Tungsten (*) 3) Do the following metals (necessary to the functionality or production of your products) come from a recycler or scrap supplier? (*) Tantalum (*) Tin (*) Gold (*) Tungsten (*) 4) Have you received completed Conflict Minerals Reporting Templates from all of your suppliers? (*) Tantalum (*) Tin (*) Gold (*) Tungsten (*) 5) For each of the following metals, have you identified all of the smelters your company and its suppliers use to supply the products included within the declaration scope indicated above? (*) Tantalum (*) Tin (*) Gold (*) Tungsten (*) 6) Have all of the smelters used by your company and its suppliers been validated as compliant in accordance with the Conflict-Free Smelter (CFS) Program and listed on the Compliant Smelter List for the following metals? (*) Tantalum (*) Tin (*) Gold (*) Tungsten (*)Answer the Following Questions at a Company Level

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Link to "CFS Compliant Smelter List"Answer Comments

Question A. Do you have a policy in place that includes DRC conflict-free sourcing? (*)

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B. Is this policy publicly available on your website? (*)

C. Do you require your direct suppliers to be DRC conflict-free? (*)

D. Do you require your direct suppliers to source from smelters validated as compliant to a CFS protocol using the CFS Compliant Smelter List? (*)

E. Have you implemented due diligence measures for conflict-free sourcing? (*)

F. Do

you request your suppliers to fill out this Conflict Minerals Reporting Template? (*)

G. Do you request smelter names from your suppliers? (*)

H. Do you verify due diligence information received from your suppliers? (*)

I. Does your verification process include corrective action management? (*) J. Are you subject to the SEC Conflict Minerals disclosure requirement rule? (*)© 2011 Electronic Industry Citizenship Coalition, Incorporated and Global e-Sustainability Initiative. All rights reserved.