Bureau Veritas Sustainability Service Application Form

BUREAU VERITAS SUSTAINBLE CHEMICAL MANAGEMENT PROGRAM
必維可持续化学品管理项目
APPLICATION FORM 申请书
Page 1 of 7
*Mandatory field 必须填写
APPLICANT INFORMATION 申请人资料
*Brand Association
品牌关联:
*Full Company Legal Name

公司完整法定名称:
*Address
地址:
City State/Province Postal Code Country

市: 州/省: 邮政编码: 国家:
Contact Person Email

联系人: 电邮:
Tel 联系电话: Fax 传真:
*Service Request 服务类型
BVE3
Wastewater Testing 废水测试
Chemical Audit 化学品审核 What chemical audit is required?
Training 培训 What training course is required?
MRSL Conformance Testing 生产限用物质清单符合性测试

Page 2 of 7
BILLING INFORMATION 票据信息

Others, please
*Payment Method 付款方式: specify
其他请注明:
*Company 公司:
*Address 地址:
*Contact Person 联系人: E-mail 电邮:
Tel 联系电话: Fax 传真:
1. BV CPS Conditions of Service
All services of Bureau Veritas Consumer Products Services Division are strictly offered, and can only be accepted, under the CPS
Conditions of Service. Any party that requests said services, confirms said services, or makes any payment for said services does so
agreeing automatically that: (a) it irrevocably accepts and agrees to the CPS Conditions of Service; (b) it waives all rights to change
or challenge the CPS Conditions of Service; and (c) the CPS Conditions of Service are final and, unless expressly agreed otherwise
by Bureau Veritas, any additional conditions sought to be imposed on any service or payment shall be invalid. The CPS Conditions of
Service can be accessed through this link: http://www.bureauveritas.com/home/about-us/our-business/cps/about-us/terms-conditions/
2. Special Charges
(i) Access Denied Charge
In the event that the scheduled services are not performed due to Client’s production unit not allowing CPS personnel to enter or
conduct the relevant sampling, verification, audit and/or assessment (collectively, “Scheduled Services”) for reason beyond the
reasonable control of CPS personnel, an access denied charge will be applied and invoiced in full based on standard man-day
charges and all expenses incurred by CPS personnel.
(ii) Late Cancellation Charge

(a) In the event that cancellation of the Scheduled Service is notified by Client less than 24 hours from the date of Scheduled
Services, and if CPS personnel cannot be re-assignedto conduct the Schedule Services, a late cancellation charge will be
applied and invoiced in full based on standard man-day charges and all expenses incurred by CPS personnel.
(b) In the event that cancellation of the Scheduled Service is notified by Client less than 48 hours and more than 24 hours
from the date of Scheduled Services, a late cancellation charge will be applied and invoiced in full based on the non-
refundable travel expensesincurred by CPS personnel.
(c) In the event that severe weather condition such as heavy rain, storm, etc. is expected to occur in the area of which Client’s
production unit is located and Client notifies CPS at least 24 hours prior to the date of Scheduled Services, the Scheduled
Services will be rescheduled free of standard man-day charges and only the non-refundable travel expensesincurred by CPS
personnel will be charged and invoiced in full based on actual cost.
(d) In the event that despite the severe weather condition such as heavy rain, storm, etc. is notforeseeable and unexpectedly
occurs on the date of Scheduled Services and CPS personnel has already arrived on-site, the Scheduled Services will be
rescheduled and nolate cancellation charge will apply unless otherwise provided in the applicable contract.
*Authorized Signature 授权人签字: *Company Chop 公司印章:
*Name of Signer 授权人姓名:

*Date 日期 :
Page 3 of 7
BVE3 APPLICATION 申請 (Please fill in English below 请用英文填写)
ZDHC InCheck BVE3 Technical Report Other 其他:

Please specify 请注明:
BVE3 User Account Creation 用户账号申请:

*Email:
*User 1
*Name of User:
Email:
User 2
Name of User:
Email:
User 3
Name of User:
*Production Unit Process Type 工厂制造类型: *Product Category 产品类型:

(select one or more 可选多于一个) (select one or more 可选多于一个)
Dyeing 染色 Accessory and Gear 配件与装备
Printing 印刷 Apparel Leather 服装皮革
Washing 洗涤 Apparel Textile 服装纺织品
Finishing 后处理 Footwear 鞋类
Other Process Type 其他制造类型 Other Category 其他类型
ZDHC Gateway Account Information 网关帐户信息

(Fill in below if applicant required InCheck 如需要InCheck报告请填写以下)
ZDHC Gateway Account 网关帐户:
✔
 Yes, I already have a Gateway ZDHC AID 账户 ID:
account. 有，我已经有网关帐户。 User Access Key 用户密钥:
 No, I would like to apply Contact Name:

Gateway account for InCheck.
沒有，我想申请网关帐户給出具 Primary Email:
InCheck 報告。 Organization Name:

Page 4 of 7
✔ WASTEWATER TESTING APPLICATION 废水测试申請
ZDHC Wastewater Testing
Other Wastewater Testing, please specify:
Type of Sample 采样类型: Sampling Method 采样方法:

Incoming water 進水 (optional)
Raw Wastewater 原废水
Discharged Wastewater 排出废水
Sludge 污泥 Please select sampling method
Sampling Information 采样信息

Client Project No. / Reference No. (if any):
Proposed Sampling Date 采样日期 :
Discharge Type 排放类别:
Wastewater Discharged Point (if applicable)

废水排放点（如适用）:
On-site ETP 厂内污水处理站

Effluent Treatment Plant (ETP) 污水处理 :
Off-site ETP 厂外污水处理站
Off-site ETP Name 厂外污水处理站名称:

Off-site ETP Address 地址:
Legal Discharge Permit and Validity (if any)

法规排污许可和有效期（如適用）:
Sample Source 样品来源 : Sample Disposal Method

样品处置方式:
Report Submitted in 报告提交方法: Report Language 报告语言:

Page 5 of 7
Wastewater Report Upload 废水报告上传
I agree that Bureau Veritas will upload my production unit’s wastewater test result to ZDHC Gateway.
我同意 Bureau Veritas 把我的生產單元廢水測試結果上傳到 ZDHC 网关。
I agree that Bureau Veritas will share and/or submit my production unit’s wastewater test result to brand
listed below.
我同意 Bureau Veritas 把我的生产单元废水测试结果分享及／或提交给以下关联品牌。
Brand Name 品牌名称:
Report receivers’ email (one or more)
报告收取人电邮（可多于一位）:
Report Upload Platform 报告上传平台
Username:
IPE 公众环境研究中心
Password:
FFC 平台
Other 其他
Page 6 of 7
MRSL CONFORMANCE TEST APPLICATION 生产限用物质清单符合性测试申請
Sample Information 样品信息
Sample 样品 1
Chemical Supplier 化学品供应商:
Chemical Formulation 化学制剂 :
Chemical Formulation Type 化学制剂类型: Please select
Batch/Lot Number 批号: Sample Type 样品类型:
SDS:  Yes 有 Self-declaration letter  Yes 有
 No 否声明书 :  No 否
Sample 样品 2
Chemical Formulation 化学制剂:
Sample 样品 3
Sample 样品 4
Page 7 of 7
Sample 样品 5

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BUREAU VERITAS SUSTAINBLE CHEMICAL MANAGEMENT PROGRAM

APPLICATION FORM 申请书

APPLICANT INFORMATION 申请人资料

*Full Company Legal Name

City State/Province Postal Code Country

Contact Person Email

Tel 联系电话: Fax 传真:

*Service Request 服务类型

Wastewater Testing 废水测试

Chemical Audit 化学品审核 What chemical audit is required?

Training 培训 What training course is required?

MRSL Conformance Testing 生产限用物质清单符合性测试

APPLICATION FORM 申请书

BILLING INFORMATION 票据信息

(ii) Late Cancellation Charge

*Name of Signer 授权人姓名:

APPLICATION FORM 申请书

BVE3 APPLICATION 申請 (Please fill in English below 请用英文填写)

ZDHC InCheck BVE3 Technical Report Other 其他:

BVE3 User Account Creation 用户账号申请:

*Production Unit Process Type 工厂制造类型: *Product Category 产品类型:

Printing 印刷 Apparel Leather 服装皮革

Washing 洗涤 Apparel Textile 服装纺织品

Finishing 后处理 Footwear 鞋类

Other Process Type 其他制造类型 Other Category 其他类型

ZDHC Gateway Account Information 网关帐户信息

ZDHC Gateway Account 网关帐户:

 No, I would like to apply Contact Name:

InCheck 報告。 Organization Name:

APPLICATION FORM 申请书

✔ WASTEWATER TESTING APPLICATION 废水测试申請

ZDHC Wastewater Testing

Other Wastewater Testing, please specify:

Type of Sample 采样类型: Sampling Method 采样方法:

Sampling Information 采样信息

Proposed Sampling Date 采样日期 :

Discharge Type 排放类别:

Wastewater Discharged Point (if applicable)

On-site ETP 厂内污水处理站

Off-site ETP Name 厂外污水处理站名称:

Legal Discharge Permit and Validity (if any)

Sample Source 样品来源 : Sample Disposal Method

Report Submitted in 报告提交方法: Report Language 报告语言:

APPLICATION FORM 申请书

Wastewater Report Upload 废水报告上传

Report Upload Platform 报告上传平台

APPLICATION FORM 申请书

MRSL CONFORMANCE TEST APPLICATION 生产限用物质清单符合性测试申請

Sample Information 样品信息

APPLICATION FORM 申请书

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Production Unit Process Type 工厂制造类型: Product Category 产品类型: