104.针对IOS-MAT-0010聚合物包括塑料、硅胶、和橡胶弹性体乳胶体材料的自我声明IOS-MAT-0010_SD

Self-declaration form

Polymerics materials

Spec. nr:

Date:

Version nr

IOS- MAT-0010

2013-05-10

AA-10911-11

Self declaration for polymerics including plastics, silicone and rubber/

elastomers/ latex, according to IOS-MAT-0010

针对

IOS-MAT-0010

聚合物 包括塑料、硅胶、和橡胶

/

弹性体

/< /p>

乳胶体材料的自我声明

This form shall be used to certify compliance with requirements according to specification

IOS- MAT-

0010

(AA-10911-11). This form-or an equivalent form with the same information- is to be signed by the

final formulator(material producer) of the final polymeric material, i.e. the moulder or extruder(or the

supplier of granules if they are pre-coloured and the moulder/ extruder does not add any additives

when forming the plastic component ). This can be either the IKEA supplier or a sub-supplier(or a sub-

sub-supplier, etc).

此文件是针对

IOS-MAT-0010(AA-10911- 11)

的符合性声明。此文件或具备同等信息的声明文件由聚合物完结材料

的最终成型方（材料生产商）签署，即成型或挤出供应商（或进行预着色的粒子供应商，如果成型或挤 出方在制作塑料

部件时未添加任何化学助剂）。该签署人可以是宜家供应商或其下级供应 商（或下

-

下级供应商，等）。

The self declaration shall be in English

–

addition of information in local language is voluntary

.

自我声明必须是英文的，以当地语言陈述的附加信息仅作参考。

Supporting documents, verifying fulfillment of the requirements, shall be listed in

Table 4

, such as:

?

?

Test reports,

Self declarations or certificates from sub-suppliers of raw material and chemicals used to make

the polymeric material.

支持文件 ，即证实可以满足要求的文件，须列在表

4

中，比如：

?

?

测试报告

来自于生产该聚合材料所需的原材料和化学产品的下级供应商的自我声明或证书。

Table 1. List of polymeric material materials

表

1.

聚合物材料清单

Material identification(trade

name, article code, quality

and/or other identification)

材料识别信息（商品名，产 品编

码，质量和

/

或其它识别信息）< /p>

1

1

Material description (type of

material such as material base

content, physical

characteristics, colour ect)

材料描述（材料类别例如材料基本内

容，物理特性，颜色等）

Contains

only virgin

polymeric

material

仅含未经使用

的聚合材料

Contains external recycled

polymeric(state range of

percentage of external recycled

material)

含有来自于外部的回收聚合材料（具

体说明所含外部回收材料的比例）

Page 1

? IKEA of Sweden AB ? 2013

Self- declaration form

Polymerics materials

Table 2. Confirmation of fulfillment of chemical requirements

表格

2

，对化学品要求的确认

Spec. nr:

Date:

Version nr

IOS-MAT-0010

2013-05-10

AA-10911-11

Requirements Type of polymeric material

Fulfils Not

See

IOS-MAT-0010

for specific

applicable

information on each requirement

聚合材料的类型

满足

不适用

要求：参见

IOS- MAT-0010

各具体要求

Authorisation substances according All

1

to EU REACH Annex XIV

所有

授权物质（依据欧盟

法规附录

XIV

）

Cadmium and its compounds All

镉及镉的化合物

所有

CMR substances 1A or1B

All

1A

或

1B

类

CMR

物质

所有

Hazardous waste Material that contains any

有害废料

proportion of recycled material

材料中包含任何比例的回收材料

Lead and its compounds All

铅及铅的化合物

所有

Other SVHC

All

其他

SVHC

所有

PBT-substances and vPvB- substances

All

PBT-

物质（持久的，生物累积的和有毒的物质）

所有

< /p>

和

vPvB-

物质（高持久的和高生物累 积的物质）

1

1

1

1

Azodyes that may release Materials where colouring

carcinogenic arylamines agents have been added

可能释放致癌芳香胺的偶氮染料

材料中添加有着色粒子

Bisphenol A Plastic material

双酚

A

塑料材料

CFCs(Chlorofluorocarbons) and Foamed plastic

HCFCs(hydrochloro-fluorocarbons)

泡沫塑料

C FCs

（氟氯烷烃）和

HCFCs

（氢 氯氟烷烃）

Heavy metal(extractable) All

重金属（可析出）

所有

1

When referring to chemical substances that are included in lists established by government authorities, this SD applies to

chemical substances that are included in such list at the time of signing.

对 引用来自政府制定的法规和标准里面的化学物质清单时，此声明适用于签署时清单里的物质。

? IKEA of Sweden AB ? 2013

Page 2

Self-declaration form

Polymerics materials

Table 2. Confirmation of fulfillment of chemical requirements

表格

2

， 对化学品要求的确认

Spec. nr:

Date:

Version nr

IOS-MAT-0010

2013-05-10

AA-10911-11

Requirements Type of polymeric material

Fulfils Not

See

IOS-MAT-0010

for specific

applicable

information on each requirement

聚合材料的类型

满足

不适用

要求：参见

IOS- MAT-0010

各具体要求

Hexavalent chromium(Cr-VI) All

compounds

所有

六价铬化合物

(Cr-VI)

Lindane Materials consisting wholly or

林丹

partly of natural latex/rubber

材料由全部或部分天然乳胶

/

橡胶组成

Mercury(Hg) and its compounds All

汞

(Hg)

及汞的化合物

所有

Organotin compounds All

有机锡化合物

所有

Pentachlorophenol(PCP) including Materials consisting wholly or

salts and esters of PCP partly of natural latex/rubber

五氯苯酚

(PCP)

包括

PCP

的盐类和酯类

材料由全部或部分天然乳胶

/

橡胶组成

Phthalates All

邻苯二甲酸酯

所有

Polycyclic aromatic hydrocarbons All

except

rubber components that

(PAH) contain carbon black, that are with-

稠环芳烃

(PAH) out skin-contact during usage, and

where tensile and abrasion wear

properties are needed

所有，除了橡胶组件如含有碳黑，非皮

肤接触用途，需具有可拉伸及磨损特性

Polycyclic aromatic hydrocarbons Rubber components that

(PAH)

（

exception: higher CLVs

）

contain carbon black, that are with-

稠环芳烃

(PAH) (

例外：高

CLV

物质

) out skin-contact during usage, and

where tensile and abrasion wear

properties are needed

橡胶组件如含有碳黑，非皮肤接触用途，

需具有可拉伸及磨损特性

Polyvinyl-chloride(PVC) All

聚氯乙烯（

PVC

）

< br>

所有

? IKEA of Sweden AB ? 2013

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