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Commitment &
Declaration on
Dangerous
Substances
To be used as is U Reference : ENG-FRM-001
Version : E
Application date : April 17
Purpose
This document belongs to the process Engineering
Commitment to respect legal provisions relating to the marketing & the use of dangerous substances
Scope of application
The present document is applicable to all ALSTOM Transport Product Lines and their suppliers.
Accountable: Regions
Signatures
<Amandine
Verified by : Sustainable Sourcing Manager Date of signature Electronic signature
NOURELDIN>
<Véronique
Approved by : Ecodesign Director Date of signature Electronic signature
ANDRIES>
Nota for Work Method Statements/ instructions (text to be removed when issuing the document):
The supplier is requested to fill in the form below, in order to ensure that the legal and contractual requirements concerning the dangerous substances are applied. This form is a compliance
1 commitment to ALSTOM requirements, as defined in the ENG-STD-003. This commitment covers all the references supplied to ALSTOM on the specified project.
The supplier is also requested to fill in the form called "Dangerous Substances Form" in order to declare the presence of dangerous substances in the supplied articles or preparations, according to
the section 1.2 of the specification ENG-STD-003.
2 This form must cover all the supplied references, for which the supplier must notice if dangerous substances (not only SVHC) are present.
For references that contain dangerous substances, the supplier must report all the requested about the present substances.
When relevant (e.g. change of composition, regulatory update) the information shall be updated.
This commitment declaration form shall be remitted at the tendering stage and the Dangerous Substances Form shall be remitted during the preliminary and detail design phase during which it will undergo the
different reviews. These forms shall also be filled in and remitted upon request out of the previously specified phases.
Reference or order N° :
Order number
(to be filled in only when ordering)
GEOGRAPHIC LOCALISATION OF ACTIVITIES (to be filled in by the Tsick the relevant box
✘ in European Economic Area
For the scope of supply concerned in the declaration, the supplier activities are located
✘ out of European Economic Area
Please fulfill the form below corresponding to OUT OF the EEA activities
Please give the contact details of this Contact details (e-mail address & Please give the contact details of this Contact details (e-mail address &
person telephone number) person telephone number)
All necessary actions have been All necessary actions have been
Section performed towards your own suppliers Section performed towards your own suppliers
YES YES
2.3.c in order to ensure your REACH 3.3.c in order to ensure your hazardous
compliance substances regulation compliance
ENG-STD-
For non-EU suppliers of substances or
003 Tick the relevant box
mixtures only :
reference
If relevant, do you have appointed an
Only Representative according to NON
YES NO
section 2.4 of the specification ENG- RELEVANT
STD-003 ?
Section 2.4 - If "non relevant", please provide
Justification for non relevance
short explanations
- If "Yes", please provide contact
Contact details
details of the Only Representative
In witness
Signature : "Signature" whereof, signed
at :
UNCONTROLLED WHEN PRINTED – Not to be used before verification of applicable version number
Property of Alstom Transport - cannot be distributed or reproduced without authorization.
Name of supplier : Supplier name ALSTOM Transport site requester :
Project : Name of project
Information on Subst
formation on Substances
diisobutyl phthalate
D(FA) 0.4
P(AR) 1.5
D(FI) 7
D(FA) 0.15
D(FI) 0.1
D(FI) 0.05
n on weight & weight
percentage
20
10000
10000
4200
4200
320
A – Definitions and References
A–1 Definitions
[R1] ENG-STD-003 Instructions to Suppliers concerning the placing on the market and use of h
s, subsequent amendments
blication referred to