3. Where products include any of substances 1) – 4), 6) or 7) that fall under the items in attached sheet C) List of Exempted Items, enter the exempted item No(s). and nature of the exemption(s) (application, grounds for decision, etc)
Exempted Item No. Nature of exemption (application, grounds for decision, etc)
For further information contact the representative below: Name:
Department:
Tel:
E-Mail:
[Vendor]
Company name:
Signature:
[Trading company]
Company name of trading company:
Signature: