Scanfil›Supplier Application Form Supplier Application Form Supplier Application Form 1. Company informationcompany nameaddress 1Association No. / Registtration No.address 2phoneCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandswebsiteDUNS numberVAT number0 of 10 max characters 2. Contactsmanaging directorPhoneEmail salesPhoneEmail qualityPhoneEmail order receiptPhoneEmail forecast receiptPhoneEmail 3. Cooperation termsterms of paymentDays, numbers onlyincotermsplease select termsCIPCPTDAPDDPEXWFCAFOBUntitledEURUSDCNYSEKPLNGBPJPYCHF 4. Geographical footprintGeographical footprint national regional / continental global National Lorem ipsum dolor sit amet, consectetur adipiscing elit. Aenean eget nibh dictum, auctor ipsum in, cursus odio. In sit amet augue posuere, consequat erat vitae, facilisis leo. Nulla rhoncus semper condimentum. Morbi laoreet libero eget tempor euismod. Donec in tortor at augue porta mollis eget non nunc. Suspendisse ut auctor. regional / continental Lorem ipsum dolor sit amet, consectetur adipiscing elit. Aenean eget nibh dictum, auctor ipsum in, cursus odio. In sit amet augue posuere, consequat erat vitae, facilisis leo. Nulla rhoncus semper condimentum. global Lorem ipsum dolor sit amet, consectetur adipiscing elit. Aenean eget nibh dictum, auctor ipsum in, cursus odio. In sit amet augue posuere, consequat erat vitae, facilisis leo. Nulla rhoncus semper condimentum. 5. Certificates ISO 9001 ISO 14001 ISO 13485 IATF 16949 ISO 45001 Others 6. A Type of Business Manufacturing Distribution Indirect / Consumables Services & consultancies 6. B Category area Mechanics Customized Electro-mechanics u000band Modules Electronics Others 7. Rohs, reach, conflict minerals7.1 Do you have a system to ensure compliance to RoHS directive 2011/65/Eu or newer?7.1 Do you have a system to ensure compliance to RoHS directive 2011/65/Eu or newer? Yes No comments7.2 Can you provide of RoHS compliance, or all deliveries?7.2 Can you provide of RoHS compliance, or all deliveries? Yes No comments7.3 Do You have a system to ensure compliance to the REACH directive No 1907/2006 or newer?Do You have a system to ensure compliance to the REACH directive No 1907/2006 or newer? Yes No comments7.4 Can Your company provide documentation for REACH compliance, for all deliveries?7.4 Can Your company provide documentation for REACH compliance, for all deliveries? Yes No comments7.5 Do You have a system to ensure compliance to the Dodd-Frank Act (Conflict minerals usage)Do You have a system to ensure compliance to the Dodd-Frank Act (Conflict minerals usage) Yes No comments7.6 Can you provide CMRT to confim your compliance to Dodd-Frank act?Can you provide CMRT to confim your compliance to Dodd-Frank act? Yes No comments 8. Sustainability8.1 Do You have a sustainability program ? Yes No 8.2 Can you provide Full MDS (Material Data Sheet) for all your products? Yes No 8.3 Can you declare Carbon Footprint for your products? Yes No 9. A Ownershipownership private joint venture state owned public other 9. B Company InfoMain owners / shareholdersnumber of employeesyear of establishment 9. C Finance last Year (EUR)net salesebitEquity ratio %(Total Shareholders Equity/Total Assets) 9. D Your 3 main customers in % of Turn-over#1% #2% #3% 10. Bank informationbank nameaccount no. or ibanbank addressBIC-code (formerly Swift Code) 11. Scanfil Basic RequirementI have read and agree to the Terms in Scanfil Basic requirements* I have read and agree to the Terms in Scanfil Basic requirements. 12. Scanfil Code of ConductI have read and agree to the Terms in Scanfil Code of Conduct* I have read and agree to the Terms in Scanfil Code of Conduct Date MM slash DD slash YYYY Name*position / title:Email*