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SUPPLIER DECLARATION – EU REACH Regulation, Substances of Very High Concern (SVHC) and Restricted Substances

PLEASE NOTE: Declaration must cover all products supplied to Debenhams in 2016

SUPPLIER DETAILS
Company: Manufacturer
(„Supplier“)
Distributor
Contact:
(name, phone
and email)

PRODUCT DETAILS
Brand/Trademark Type (e.g. Toy or electronic
equipment)
Does your product PVC1 plastic: PU2 Foam: PU2 Coating:
contain any of the
following material types? Transfer Print: Polyester: Synthetic Rubber:
(Mark with X if relevant) Synthetic Leather: Coated Metal components: Electrical Components:
IMPORTANT!
PLEASE ALSO COMPLETE THE QUESTIONNAIRE IF YOUR PRODUCT CONTAINS ONE OR MORE OF THE ABOVE IDENTIFIED
MATERIALS
1 PVC = Polyvinyl Chloride 2 PU = Polyurethane

TICK the below relevant boxes to declare content of SVHC and Annex 17 restricted substances

SVHC concentration in articles below 0,1% w/w per component.

We, the supplier, hereby state and declare that the articles including packaging satisfy the requirements that are defined in Article 33 of
Regulation (EC) No. 1907/2006 (REACH regulation) and we also confirm that there is no substance from the latest official SVHC candidate
list as per REACH definition, present in the article including packaging mentioned above in concentrations higher than 0.1% w/w. (The
official Candidate List can be found on the ECHA website http://echa.europa.eu.) – the Candidate List is updated regularly and Supplier
is required to update the information in the Declaration and the questionnaire on supplied products as appropriate.
The supplied articles and/or their packaging, supplied to our customer or its subsidiary companies does not contain Substances of Very
High Concern (SVHC) in a concentration exceeding 0.1% w/w.

SVHC concentration in articles exceeding 0,1% w/w per component – please also fill in the detailed
questionnaire
We, the supplier, hereby state and declare that the supplied article including packaging satisfy the requirements that are defined in Article 33
of Regulation (EC) No. 1907/2006 (REACH regulation) and we also confirm that the substance identified by us in the detailed questionnaire
from the latest official SVHC candidate list as per REACH definition, are present in the article including packaging mentioned above in
concentrations higher than 0.1% w/w. (The official candidate list can be found on the ECHA website http://echa.europa.eu.) - the Candidate
List is updated regularly and Supplier is required to update the information in the Declaration and the questionnaire on supplied
products as appropriate.
The supplied articles and/or their packaging, supplied to our customer or its subsidiary companies contain the Substances of Very High
Concern (SVHC) in a concentration exceeding 0.1% w/w that are identified by us in the detailed questionnaire.

Restricted Substances in REACH Annex 17 – please also fill in the detailed questionnaire
We, the supplier, hereby state and declare that the supplied article including packaging satisfy the requirements that are defined in Title VIII
of Regulation (EC) No. 1907/2006 (REACH regulation), including the restrictions listed in Annex 17 of REACH. Annex 17 of REACH can be
found on the ECHA website http://echa.europa.eu. – Annex 17 is updated regularly and Supplier is required to update the information
in the Declaration and the questionnaire on supplied products as appropriate.
The supplied articles and/or their packaging, supplied to our customer or its subsidiary companies contain Annex 17 Substances that are
identified by us in the detailed questionnaire.

Date, Signature,
Supplier Company Seal
Signature with legally binding effect

Intertek Health and Environment – EU REACH SVHC/Annex 17 Self Declaration 2015

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