To ensure all required fields have been populated before submitting to your customers review form for any line items highlighted in red Required fields remaining to be completed
Click here to return to Declaration tab Click here to return to Smelter List 47
Required Fields Answer provided Notes Hyperlink to source
Company Name (*): Provide your company name on the Declaration tab cell D8 Click here to enter Company Name
Declaration Scope or Class (*): Select the scope of declaration on the Declaration tab cell D9 Click here to enter Declaration Scope
Description of Scope: Complete
Contact Name (*): Provide contact name in Declaration tab cell D15 Click here to enter Contact Name
Email – Contact (*): Provide an email for contact in Declaration tab cell D16 Click here to enter Email-Contact
Phone – Contact (*): Provide a phone number for contact in Declaration tab cell D17 Click here to enter Phone-Contact
Authorizer (*): Provide authorized company representative contact name in Declaration tab cell D18 Click here to enter an Authorized Company Representative's name
Email - Authorizer (*): Provide an email for authorized company representative on Declaration tab cell D20 Click here to enter Representative's email
Phone - Authorizer (*): Provide a phone number for authorized company representative on Declaration tab cell D21 Click here to enter Representative's phone
Effective Date (*): Provide date the form was completed on Declaration tab cell D22 Click here to enter Date of Completion
1) Is the 3TG intentionally added to your product? (*)
Tantalum (*) Declare if Tantalum is intentionally added to your products on Declaration tab cell D26 Click here to answer question 1 for Tantalum
Tin (*) Declare if Tin is intentionally added to your products on Declaration tab cell D27 Click here to answer question 1 for Tin
Gold (*) Declare if Gold is intentionally added to your products on Declaration tab cell D28 Click here to answer question 1 for Gold
Tungsten (*) Declare if Tungsten is intentionally added to your products on Declaration tab cell D29 Click here to answer question 1 for Tungsten
2) Is the 3TG necessary to the production of your company’s products and contained in the finished product that your company manufactures or contracts to manufacture? (*)
Tantalum (*) Declare if Tantalum is necessary to the production of your products and contained within the finished products declared in Declaration tab cell D32 Click here to answer question 2 for Tantalum
Tin (*) Declare if Tin is necessary to the production of your products and contained within the finished products declared in Declaration tab cell D33 Click here to answer question 2 for Tin
Gold (*) Declare if Gold is necessary to the production of your products and contained within the finished products declared in Declaration tab cell D34 Click here to answer question 2 for Gold
Tungsten (*) Declare if Tungsten is necessary to the production of your products and contained within the finished products declared in Declaration tab cell D35 Click here to answer question 2 for Tungsten
3) Do any of the smelters in your supply chain source the 3TG from the covered countries? (SEC term, see definitions tab) (*)
Tantalum (*) Declare if Tantalum used within the scope of products declared within this survey response originated from the DRC or an adjoining Country on the Declaration tab cell D38 Click here to answer question 3 for Tantalum
Tin (*) Declare if Tin used within the scope of products declared within this survey response originated from the DRC or an adjoining Country on the Declaration tab cell D39 Click here to answer question 3 for Tin
Gold (*) Declare if Gold used within the scope of products declared within this survey response originated from the DRC or an adjoining Country on the Declaration tab cell D40 Click here to answer question 3 for Gold
Tungsten (*) Declare if Tungsten used within the scope of products declared within this survey response originated from the DRC or an adjoining Country on the Declaration tab cell D41 Click here to answer question 3 for Tungsten
4) Does 100 percent of the 3TG (necessary to the functionality or production of your products) originate from recycled or scrap sources? (*)
Tantalum (*) Declare if Tantalum used within the scope of products declared within this survey