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English
December 23, 2021
Revision 1.01
The purpose of this document is to collect sourcing information on cobalt or natural mica.
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 (*):
Go to Product List tab to enter products this declaration applies to
Company Unique ID:
Company Unique ID Authority:
Address:
Contact Name (*):
Email – Contact (*):
Phone – Contact (*):
Authorizer (*):
Title - Authorizer:
Email - Authorizer (*):
Phone - Authorizer:
Effective Date (*):
Bivar
B. Product (or List of Products)
Click here to enter the products this declaration applies to
02-887-2869
02-887-2869
4 Thomas, Irvine CA 92618
Farzin Farsio
949 951-8808
Farzin Farsio
Quality Manager
949 951-8808
19-Jan-2022
Answer the following questions 1 - 7 based on the declaration scope indicated above
1) Is any of the cobalt or natural mica intentionally added or used in the product(s) or in the production process? (*)
Answer
Comments
Cobalt
Mica
No
No
2) Does any cobalt or natural mica remain in the product(s)? (*)
Answer
Comments
Cobalt
Mica
3) Do any of the smelters or processors in your supply chain source the cobalt or natural mica from conflict-affected and high-risk areas? (OECD Due Diligence Guidance, see definitions tab)
Answer
Comments
Cobalt
Mica
4) Does 100 percent of the cobalt originate from recycled or scrap sources?
Answer
Comments
Cobalt
5) What percentage of relevant suppliers have provided a response to your supply chain survey?
Answer
Comments
Cobalt
Mica
6) Have you identified all of the smelters or processors supplying the cobalt or natural mica to your supply chain?
Answer
Comments
Cobalt
Mica
7) Has all applicable smelter or processor information received by your company been reported in this declaration?
Answer
Comments
Cobalt
Mica
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.)
No
C. Do you require your direct suppliers to source cobalt from smelters or natural mica from processors whose due diligence practices have been validated by an independent third-party audit program?
Cobalt
No
Mica
No
D. Have you implemented due diligence measures for responsible sourcing?
Yes
E. Does your company conduct cobalt and/or natural mica supply chain survey(s) of your relevant supplier(s)?
Yes, in conformance with IPC1755 (e.g. EMRT)
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
© 2021 Responsible Minerals Initiative. All rights reserved.
Manufacturer's Product Number (*)
Manufacturer's Product Name
Comments
H301CYGDL-180
© 2021 Responsible Minerals Initiative. All rights reserved.