Basf Coatings Raw Material Supplier Approval Form

BASF Corporation

HELPING MAKE PRODUCTS BETTER™

RETURN COMPLETED INFORMATION TO: For BASF Product Regulations only: BASF CORPORATION SAP Code Temporary Code Permanent Code 26701 Telegraph Rd. Southfield, MI 48034 HMIS BI number Attn: Mike Meyer Email: [email protected] Fax # 248-948-2249 BASF COATINGS RAW MATERIAL REGULATORY CHECKLIST Complete all sections; forward any changes to BASF. Attach additional pages as necessary TRADE NAME: ______SUPPLIER CODE: ______CHEMICAL NAME: ______WT/GAL or SPEC. GRAV. ______SUPPLIER NAME ______BASF CONTACT/REQUESTOR ______ADDRESS______PHONE ______BUSINESS UNIT ______Supplier contact completing request (Name/Title & Phone) RAW MATERIAL TYPE ______Name/Title______Phone ______ATTACH THE FOLLOWING (REQUIRED): MSDS, PRODUCT DATA SHEET AND PRODUCT HAZARD COMMUNICATION LABEL. PLEASE PROVIDE ANY UNPUBLISHED TOXICITY STUDY SUMMARIES (ANIMAL OR ECO-TOX)

REGULATORY INFORMATION (Please verify compliance with the items listed below. N/A – not available) SUBJECT Yes No N/A Comments Global Chemical Inventories – Is the product (components) listed on Please site exemptions, restrictions or other the following inventories: listings (polymer, low volume, NDSL,etc). TSCA (USA) EINECS (Europe) DSL (Canada) MITI/ENCS (Japan) AICS (Australia) KECL (Korea) PICCL (Philippines) China (draft) Is the product subject to TSCA Sect. 4, 6, 7, 8d or 12 (b) Is the product cleared for use in food contact applications in the Please site specific regulatory reference and use USA or Other Countries limitations. List substance and wt % (including trace) for any of the following in product except where included on full disclosure: Heavy Metals (as As, Cd, Cr6+, Hg, Pb) Azo-containing compounds (e.g., Azo dyes/pigments) Organotin Compounds Materials of animal origin If yes, please define Materials of plant origin (Food Allergy concerns) If yes, please specify. Chemical Weapons Convention Scheduled chemicals If yes, which country, which component

Polybrominated biphenyls (PBBs) or ethers (PBDEs) Halogenated Materials including Hexachlorobenzene (HCB), PCBs If yes, please identify by CAS and include the wt or other Persistant Organic Pollutants (POPs) % in the product at any level Phthalates identified by the following CAS numbers If yes, please identify by CAS and include the wt [84-74-2] [117-81-7] [26761-40-0] [84-75-3] [85-68-7] [28553-12- % in the product at any level 0] Natural Rubber Latex or silicone oils If yes, initiate MOC Is the product regulated for air, land or sea transport Identify the country of origin. Attach NAFTA Certificate of Origin (if USA, Mexico, Canada)

100% DISCLOSURE (HAZARDOUS – NON-HAZARDOUS COMPONENTS) CAS#, PMN#, OR STATE RIGHT-TO-KNOW NUMBERS AND TYPICAL % WT FOR ALL COMPONENTS. IF TRADE SECRET, PLEASE PROVIDE ADEQUATE CHEMICAL DESCRIPTION. CHEMICAL DESCRIPTION CAS# or PMN # or EAN # % Wt Attach additional sheets if necessary

BASF COATINGS RAW MATERIAL SUPPLIER APPROVAL FORM

Please complete the required information below: REQUIREMENT STATUS COMMENTS MSDS – Please send an electronic version of your 100% full Yes No MSDS If not full disclosure MSDS, Supplier disclosure MSDS to your BASF contact and to must send letter specifically stating [email protected]. OR Yes No Letter material is free of silicone Letter – Please send a letter stating material is silicone free to your BASF contact and to [email protected] Product Hazard Communication Label – Please provide a Yes No copy of the Product Hazard Communication Label. Product Data Sheet – Please provide a copy of the data Yes No sheet for this product. Shelf Life - Please provide an accurate shelf life for the Shelf Life ______product being approved. Unit (mth, yr) _____ Recertification Process – Please indicate your normal Yes No Please attach process process for recertification of this material, should it exceed the designated shelf life. Supplier Agreement on Specifications – Please send the Yes No raw material control plan agreement. Certificate of Analysis – Please provide a copy of the Yes No Certificate of Analysis based on agreement. ISO9001 Certification – Is your company ISO certified? If Yes No If in-process so, please provide a copy of your certificate. Expected certification date:______Management of Change Process (MOC) – Please indicate Yes No your receipt and understanding of the MOC process. Delivery Requirements – Please indicate your receipt and Yes No understanding of BASF’s delivery requirements. Supplier Quality Report Card (SQRC) – Please indicate Yes No your receipt and understanding of your submission requirements for the SQRC. Contact Information Verified (below) Yes No

. Supplier Production Part Approval Process – Please be aware that your company may be contacted by BASF Supplier Quality to participate in a supplier PPAP for your product.

. Supplier Contact Information – BASF requires both a General Contact and Requirements Coordinator designated. The General Contact is responsible for responding to any product nonconformities. They will also act as the communications liaison between your company and BASF. The Requirements Coordinator will be responsible for receiving and obtaining approval of our specifications designated on the BASF Raw Material Control Plan.

Please provide the following information: General Contact Requirements Coordinator Name: Name: Title: Title: Address: Address:

Phone: Phone: Fax: Fax: Email : Email :