101=80.针对IOS-MAT-0010材料的总体自我声明IOS-MAT-0010_SD_general.docx

Self-declaration formChemical compounds and substancesSpec. nr: Date: Version nrIOS-MAT-00102013-05-10AA-10911-11Self declaration for other material according to IOS-MAT-0010针对IOS-MAT-0010材料的总体自我声明This form-or an equivalent form shall be used to certify compliance with the general requirements according to specification IOS-MAT-0010(AA-10911-11) for glass, ceramics and other material that dont have material-specific sections in IOS-MAT-0010. This form shall be signed by the producer(final chemical processor)of the material. This can be either the IKEA supplier or a sub-supplier(or a sub-sub-supplier, ect).此文件或具备同等信息的声明文件，是针对IOS-MAT-0010(AA-10911-11)中的玻璃，陶瓷，及其它材料 (在技术规范IOS-MAT-0010中没有特定章节要求)的总体要求的符合性声明。该文件应由材料生产商（最终化学品处理方）签署。该签署人可为宜家供应商或下级供应商（或下-下级供应商，等）。The self declaration shall be in English- addition of information in local language is voluntary.自我声明必须是英文的，以当地语言陈述的附加信息仅作参考。Supporting documents, verifying fulfillment of the requirements, shall be listed in Table 3, such as: Test reports, Self declarations or certificates from sub-suppliers of raw materials and chemicals used to produce material.支持文件，即证实可以满足要求的文件，须列在表3中，比如： 测试报告 来源于原材料下级供应商和化学品供应商的自我声明和证书。Table 1. List of materials表1. 材料列表Material identification(trade name, article code, quality and/or other identification) 1材料识别信息（商品名，产品编码，质量和/或其它识别信息）1Material description (type of material such as material base content, physical characteristics, colour ect)材料描述（材料类别例如材料基本内容，物理特性，颜色等）Material identification(trade name, article code, quality and/or other identification) 1 材料识别信息（商品名，产品编码，质量和/或其它识别信息）1Material description (type of material such as material base content, physical characteristics, colour ect)材料描述（材料类别例如材料基本内容，物理特性，颜色等）1 If the final material in itself is the complete IKEA article, then IKEA article names and numbers can be given. 如果最终材料自身为宜家完整产品，那么需要提供宜家商品名和编号。Table 2. Confirmation of fulfillment of chemical requirements表2. 对化学品要求的确认Requirements Type of material Fulfils NotSee IOS-MAT-0010 for specific 材料种类 满足 applicable information on each requirement 不适用要求：参见IOS-MAT-0010各具体要求Authorisation substances according All to EU REACH Annex XIV2 所有授权物质（依据欧盟REACH法规附录 XIV）2 Cadmium and its compounds All 镉及镉的化合物 所有CMR substances 1A or1B2 All 1A或1B类CMR物质2 所有Hazardous waste Material that contains any 有害废料 proportion of recycled material 材料中包含任何比例的回收材料Lead and its compounds All 铅及铅的化合物 所有Other SVHC2 All 其他 SVHC2 所有PBT-substances and vPvB-substances2 All PBT-物质（持久的，生物累积的和有毒的物质） 所有和vPvB-物质（高持久的和高生物累积的物质） Fulfils Used Not (no use) (IKEA applicable 满足 approval 不适用 （未使用） required) 3 使用（需宜 家许可） Biocides of all kinds, added in order to All except glass,impart properties to the final product ceramics, enamel 用于赋予最终产品性能的各种生物杀灭剂 and metal 所有玻璃，陶瓷，搪瓷和金属除外 Fragrances All except glass, 香精 ceramics, enamel and metal 所有玻璃，陶瓷，搪瓷和金属除外 Note:”Not applicable” shall only be ticked if the material being declared is not in the scope of the requirement according to IOS-MAT-0010.注：“不适用”仅在被声明材料不属于IOS-MAT-0010要求范围之内时可选。Table 3. List of supporting documents表3. 支持文件清单Document文件Source(issuer of document)来源（文件签署人）Comments(optional)注释（可选）2 When referring to chemical substances that are included in lists established by government authorities, this SD applies to chemical substances that are included in such list at the time of signing. 对引用来自政府制定的法规和标准里面的化学物质清单时，此声明适用于签署此清单里的物质。3 Documentation as required in the approval from IKEA shall be attached to this SD. 作为宜家许可的文件需要附在此声明内。This is to certify that we have read and understood IKEA specification IOS-MAT-0010 and that the materials listed in Table 1comply with IKEA requirements according to specification IOS-MAT-0010 (AA-10911-11) .兹证明我们已阅读及理解宜家技术规范IOS-MAT-0010， 且列于表1的材料能够符合宜家技术规范MAT-0010 (AA-10911-11)的相关要求。Even if this form is signed by a sub-supplier to the IKEA supplier, IOS-MAT-0010 as part of the Purchasing Agreement between IKEA and IKEA supplier always applies, and compliance is the final responsibility of the IKEA supplier in all cases.即使此文件是由宜家供应商的下级供应商签署，作为宜家和宜家供应商采购协议的一部分IOS-MAT-0010仍然适用，且在任何情况下，满足其要求仍是宜家供应商的最终责任所在。To be filled in by the processor(final chemical producer) of the material:由材料处理方（最终化学品生产商）填写