Chemical Evaluation Formadmin2022-10-26T07:02:05+01:00 Chemical Evaluation FormGENERAL INFORMATIONSupplier Name: Product/Service: NTN Number Address Street # City State Zip Code Country Select CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSão Tomé and PríncipeSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwePhone/Mobile Fax Email Contact Person Designation Contact FACILITY PROFILEYear Established Major Customers Is the facility registered with International Standard ISO 900 1 ISO14001-2015 OEKOTEX OCS/GOTS ZDHC GreenScreen Any OtherPlease Provide ISO 9001 Document Upload Files Please Provide ISO14001-2015 Documents. Upload Files Please Provide OEKOTEX Documents. Upload Files Please Provide OCS/GOTS Documents. Upload Files Please Provide ZDHC Documents. Upload Files Please Provide GreenScreen Documents. Upload Files Please Provide Related Documents. Upload Files General Evaluation Parameters- Are you a self manufacturer or Importing Chemicals and distributing to Customer? Manufacturer Distributor- Do You Have an Organization chart with responsibilities assigned? (please attach Technical Person Contact and detail) Yes No- Do you have a system to train your new and existing staff? (If yes Please Share Details) Yes No- Will You provide MSDS (Material Safety Data Sheets) with all your chemicals? (All 16 Sections or Certified) Yes No- Will You provide TDS (Technical Data Sheets) with all your chemicals? (Batch Number must be mentioned) Yes No- Do you do internal Inspection of the Process and do you maintain its record? Yes No- Will you provide the Chemical Test reports at the time of delivery? (providing Expiry Date) Mandatory Yes NoDoes Original Pasted Labels from Manufacturer will be pasted on the Product Packages along with Hazardous Symbols for these Chemicals? (Labelling as per GHS Standard and Expiry Date/Lot Number merntioned in it.) Yes No- Do You Perform Inspection & Testing at A- Incoming Stage B- In Process Stage C- Final Stage- Do you have Customer Complaint System and Its Log Available? Yes No- Is there any system implemented to control harmful and banned substances? Yes NoPlease confirm Details you will provide on the Labels of the Container A. Manufacturer Name Yes NoB. Product Identifier Yes NoC. Hazard Pictogram Yes NoD. Signal Word Yes NoE. Precationary Statement Yes NoF. Hazrad Statements, if any Yes NoG. Batch Number Yes NoH. Manufacturing Date Yes NoI. Expiry Date Yes Noj. Weights Yes NoIf you are registered in ZDHC following applicable testing is required by 17025 Accredited laboratory 1. Azo/Arylamine Yes No2. APEO Yes No3. Formaldehyde Yes No4. Phenols Yes No5. Heavy Metals Yes No6. Phthalates Yes No7. Short Chain Chlorinated Paraffins Yes No8. Organchlorinated Compounds Yes No9. IsoCyanates Yes No10. Any Other Yes No Chemicals Details (Currently on which you are working with Kassim Textiles Pvt Ltd) Full Chemical Name UOM Package Type Package Size MSDS Available TDS Available Following Documents Received from Kassim Textile Pvt Limited and Below are my understandings. (Please note that time to time Kassim Denim will provide updates of these as well as new ones for your information and re-confirmation of abding with it) Check if "YES"ReceivedUnderstands AgreeAbide with itGTW InditexMRSL Inditex RTM InditexRSL C&A PolicyRSL LevisRSL Levis (Highlights of Major changes)RSL H&M Chemica RestrictionsRSL H&M Implementation ToolkitRSL KONTOORRSL ALDIRSL AAFARSL G-STARRSL EspritRSL Best SellerRSL TaoRSL E-LANDRSL OKAIDIRSL LIDL Chemical RestrictionsGreenScreenZDHC MRSLKASSIM Textile Purchase Protocol Terms and ConditionsRemarks (if any) I declared that all information provided in this form is true & based on factual figures to the best of my knowledge & belief. Further I also confirmed that I have understood & have accepted all the terms & Conditions & will keep following in future too. Name Designation Date / Time I have read and agree to the Terms and Conditions.Submit Form