Conflict Minerals Supplier Certification
冲突矿产供应商认证
The purpose of this document is to collect sourcing information on tin, tantalum, tungsten and gold used in private brand products sold to retailer.
Mandatory fields are noted with an asterisk (*). The information collected in this template must be updated annually.
Any changes within the annual cycle must be provided to retailer.
Vendor (Supplier) Name (*):
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Address (*):
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Authorized Company Representative Name (*):
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Representative Title (*):
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Representative Email (*):
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The information contained in this Questionnaire is, to the best of my knowledge, complete, true and accurate as of the datebelow.
Date(*):
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Signature(*):
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Name(*):
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Title(*):
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