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 MeyerEmail:
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)
Name/Title______
Phone ______/ RAW MATERIAL TYPE ______
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 Please provide any unpublished Toxicity study summaries (animal or eco-tox)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 / CommentsGlobal Chemical Inventories – Is the product (components) listed on the following inventories: / Please site exemptions, restrictions or other 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 USA or Other Countries / Please site specific regulatory reference and use 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 or other Persistant Organic Pollutants (POPs) / If yes, please identify by CAS and include the wt% in the product at any level
Phthalates identified by the following CAS numbers
[84-74-2] [117-81-7] [26761-40-0] [84-75-3] [85-68-7] [28553-12-0] / If yes, please identify by CAS and include the wt% in the product at any levelNatural 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 # / % WtAttach additional sheets if necessary
BASF COATINGS RAW MATERIAL SUPPLIER APPROVAL FORM
Please complete the required information below:
REQUIREMENT
/ STATUS / COMMENTSMSDS – Please send an electronic version of your 100% full disclosure MSDS to your BASF contact and to
Letter – Please send a letter stating material is silicone free to your BASF contact and to / Yes No MSDSYes No Letter / If not full disclosure MSDS, Supplier must send letter specifically stating material is free of silicone
Product Hazard Communication Label – Please provide a copy of the Product Hazard Communication Label.
/ Yes NoProduct Data Sheet – Please provide a copy of the data sheet for this product.
/ Yes NoShelf Life - Please provide an accurate shelf life for the product being approved.
/ Shelf Life ______Unit (mth, yr) _____
Recertification Process – Please indicate your normal process for recertification of this material, should it exceed the designated shelf life.
/ Yes No / Please attach processSupplier Agreement on Specifications – Please send the raw material control plan agreement.
/ Yes NoCertificate of Analysis – Please provide a copy of the Certificate of Analysis based on agreement.
/ Yes NoISO9001 Certification – Is your company ISO certified? If so, please provide a copy of your certificate.
/ Yes No / If in-processExpected certification date:______
Management of Change Process (MOC) – Please indicate your receipt and understanding of the MOC process.
/ Yes NoDelivery Requirements – Please indicate your receipt and understanding of BASF’s delivery requirements.
/ Yes NoSupplier Quality Report Card (SQRC) – Please indicate your receipt and understanding of your submission requirements for the SQRC.
/ Yes NoContact 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 CoordinatorName: / Name:
Title: / Title:
Address: / Address:
Phone: / Phone:
Fax: / Fax:
Email: / Email: