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Conflict Minerals Reporting Template (CMRT)
English
May 11, 2022
Revision 6.22
The purpose of this document is to collect sourcing information on tin, tantalum, tungsten and gold used in products
Mandatory fields are noted with an asterisk (*). Consult the instructions tab for guidance on how to answer each question.
Company Information
Company Name (*):
Declaration Scope or Class (*):
Description of Scope:
Company Unique ID:
Company Unique ID Authority:
Address:
Contact Name (*):
Email – Contact (*):
Phone – Contact (*):
Authorizer (*):
Title - Authorizer:
Email - Authorizer (*):
Phone - Authorizer:
Effective Date (*):
Bivar
A. Company
02-887-2869
02-887-2869
4 Thomas, Irvine CA 92618
Farzin Farsio
949 951-8808
Farzin Farsio
Quality Manager
949 951-8808
27-Jun-2022
Answer the following questions 1 - 8 based on the declaration scope indicated above
1) Is any 3TG intentionally added or used in the product(s) or in the production process? (*)
Answer
Comments
Tantalum
Tin
Gold
Tungsten
No
No
No
No
2) Does any 3TG remain in the product(s)?
Answer
Comments
Tantalum
Tin
Gold
Tungsten
3) Do any of the smelters in your supply chain source the 3TG from the covered countries? (SEC term, see definitions tab)
Answer
Comments
Tantalum
Tin
Gold
Tungsten
4) Do any of the smelters in your supply chain source the 3TG from conflict-affected and high-risk areas?
Answer
Comments
Tantalum
Tin
Gold
Tungsten
5) Does 100 percent of the 3TG (necessary to the functionality or production of your products) originate from recycled or scrap sources?
Answer
Comments
Tantalum
Tin
Gold
Tungsten
6) What percentage of relevant suppliers have provided a response to your supply chain survey?
Answer
Comments
Tantalum
Tin
Gold
Tungsten
7) Have you identified all of the smelters supplying the 3TG to your supply chain?
Answer
Comments
Tantalum
Tin
Gold
Tungsten
8) Has all applicable smelter information received by your company been reported in this declaration?
Answer
Comments
Tantalum
Tin
Gold
Tungsten
Answer the Following Questions at a Company Level
Question
Answer
Comments
A. Have you established a responsible minerals sourcing policy?
Yes
B. Is your responsible minerals sourcing policy publicly available on your website? (Note – If yes, the user shall specify the URL in the comment field.)
Yes
C. Do you require your direct suppliers to source the 3TG from smelters whose due diligence practices have been validated by an independent third party audit program?
No
D. Have you implemented due diligence measures for responsible sourcing?
Yes
E. Does your company conduct Conflict Minerals survey(s) of your relevant supplier(s)?
Yes, in conformance with IPC1755 (e.g., CMRT)
F. Do you review due diligence information received from your suppliers against your company’s expectations?
Yes
G. Does your review process include corrective action management?
Yes
H. Is your company required to file an annual conflict minerals disclosure?
No
© 2022 Responsible Minerals Initiative. All rights reserved.
Completion required only if reporting level "Product (or list of Products)" selected on the 'Declaration' worksheet.
Manufacturer's Product Number (*)
Manufacturer's Product Name
Comments
ERM 1-1.160
© 2022 Responsible Minerals Initiative. All rights reserved.