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Entry date Company nameAddressSection in charge$Signature & seal of person in chargeA person in charge is a person with the representation right of your company, or the equivalent person responsible for the contents of this certificate. 1. List of Prohibited SubstancesSubstance NameTributyl Tin Oxide (TBTO)(Certain Tributyl Tins and Triphenyl Tins;Polychrorinated Biphenyls (PCBs) and specified replacements!Polychrorinated Terphenyls (PCTs)0Certain Shortchain Chlorinated Paraffin(C10-C13)Asbestos;Phenol, 2-(2H-benzotriazol-2-yl)-4,6-bis(1,1-dimethylethyl)HexachlorobenzeneSealgN,N'-ditolyl-p-phenylenediamine, N-tolyl-N'-xylyl-p-phenylenediamine or N,N'-dixylyl-p-phenylenediamineMixture of 1,2,4,5,6,7,8,8-octachloro-2,3,3a,4,7,7a-hexahydro-4,7-methano-1H-indene, 1,4,5,6,7,8,8-heptachloro-3a,4,7,7atetrahydro-4,7-methano-1H-indene or their relative compounds (alias:Chlordane or Heptachlor)>1,1,1-trichloro-2,2-bis (p arachlorophenyl) ethane(alias: DDT)t1,2,3,4,10,10-Hexachloro-6,7-epoxy-1,4,4a,5,6,7,8,8a-octahydro-end-1,4-end-5,8-dimethyanonaphthalene (alias: Endrin)v1,2,3,4,10,10-Hexachloro-6,7-epoxy-1,4,4a,5,6,7,8,8a-octahydro-exo-1,4-endo-5,8-dimethanonaphthalene (alias: Dieldrin)e1,2,3,4,10,10-Hexachloro-1,4,4a,5,8,8a-hexahydro-exo-1,4-end-5,8-dimethanonaphthalene (alias: Aldrin)Yellow phosphorus matchHexachlorobuta-1,3-dieneK2,2,2-trichloro-1,1-bis (4-chlorophenyl) ethanol (alias: Kelsen or Dikohol)?Dodecachloropentacyclo[5.2.1.02,6.03,9.05,8]decane(alias:Mirex)MPolychloro-2,2-dimethyl-3-methylidenebicyclo[2.2.1]heptane (alias: Toxaphene)2,4,6-tri-tertbutylphenol%Dioxin group /Furan group (PCDD/PCDF)-Naphthylamine and its salts Bis(chloromethyl) ether4-Nitrobiphenyl and its salts4-Aminobiphenyl and its saltsBenzidine and its salts)Perfluorooctane sulfonyl fluoride (PFOSF)PentachlorobenzeneChlordecone (Kepone)-Hexachlorocyclohexane (-HCH)-Hexachlorocyclohexane (-HCH)*-Hexachlorocyclohexane (-HCH or Lindane)Dimethyl fumarate (i) Batteries< 10ppmTotal < 100ppm!In homogeneous materials < 100ppmCadmium / Cadmium compounds Chromium VI compoundsLead / lead compounds [(i) Electrical wires and cables coated by thermal setting and thermoplastic resin coatings (ii) BatteriesMercury / mercury compoundsPolybrominated biphenyls (PBBs)All Perfluorooctane sulfonate (PFOS)&Polybrominated diphenyl ethers (PBDEs)9Intentionally added / In homogeneous materials < 1000ppm Intentionally added}Ozone depleting substances (Substances listed in Annexes of the Montreal Protocol on substances that deplete the ozone layer)Y(i) All (In products) (ii) Used for washing/foaming 20 substances listed in Annexes A, B Textiles and leather"As formed aromatic amines < 30ppm Organic tin compound Tri(1-aziridine)-phosphine oxide"Tris phosphate (2,3-dibromopropyl)Dioctyl-tin compound (DOT)Dibutyl-tin compound (DBT)Marine productsTextiles!Intended use for mass consumptionAs tin element < 1000ppm As tin element < 2500ppm.2. List of Conditionally Prohibited SubstancesReportable Applications ThresholdIn surface coatings < 300ppm"In homogeneous materials < 1000ppm< 40ppm< 1ppmTo:P(iii) All except (i) and (ii) *Application exclusion is according to Appendix IIF(ii) All except (i) *Application exclusion is according to Appendix IIP(iv) All except (i) to (iii) *Application exclusion is according to Appendix IIV(iii) All except for (i) and (ii) *Application exclusion is according to Appendix II$fAzocolourants and azodyes which form certain aromatic amines (*) * Designated substance in Appendix IIA8List of Target Materials for the Non-Content Certificate+* If more space is needed, add extra lines.gBenzene containig rubber dough, in which benzene content exceeds 5% of the solvent (including diluents)R(ii) Packaging: Total amount of heavy metals (lead, mercury, cadmium, chromium VI)Q(i) Packaging: Total amount of heavy metals (lead, mercury, cadmium, chromium VI)S(iii) Packaging: Total amount of heavy metals (lead, mercury, cadmium, chromium VI)- 5No. 5Hexabromocyclododecane (HBCD) Endosulfan.Phthalate esters (4 types) DEHP,BBP,DBP,DIBP 8Intentionally added In homogeneous materials < 1000ppm YBenzenamine, N-phenyl-, reaction products with styrene and 2,4,4- trimethylpentene (BNST)(All (Excluding rubber other than tires) Intentionally added 'Polycyclic aromatic hydrocarbons (PAHs)LUsage in portions that contact human skin / inside of< mouth for long periods+Perfluorooctanoic acid (PFOA) and its salts FormaldehydeUsage in wood products#3. Substances that must be reportedRed phosphorus$When used, a coating must be applied1) Usage in portions of electrical equipment that contact the skin for long periods: Immediate prohibition 2) Usage as constructional element of RoHS target products: Prohibit on relevant date y* Private information in this document is only used for business relating to green procurement. Submit this if you agree. 5Pentachlorophenol 5Ed.5.0.1 5Material Code (Item No.) 5 Part Kind 5Part Model No. 5Supplier 5 Contained (NO: % / YES: )  5&Contained Substance (When left is "") 5:  Contains Mandatory Reporting Substance Red Phosphorus (%)89  5m Materials marked with "%" in the Certificate column below means that prohibited substances are not contained. m 5c When a mandatory reporting substance (red phosphorus) is contained, enter "0" in the exclusive box.KL  5tFor materials that cannot be proven as "Not contained", report those substances in the "Contained Substance" column. 5&Appendix II Edition 5.0.1 Attachment 1 5 * Details related to "Prohibited Substances", "Conditionally Prohibited Substances", and "Mandatory reporting substances" are according to Appendix II. 5 0Materials that certify not to contain prohibited substances, conditionally prohibited substances, and mandatory reporting substances are described in Form 2 Answer List.  5 0If prohibited substances, conditionally prohibited substances, and mandatory reporting substances are detected in violation to the above, resulting in damage to Fuji Electric for handling the damage, we sincerely respond to it.  53Polychloronaphthalenes (At least one chlorine atom)&Appendix II Edition 5.0.1 Attachment 1 5'Appendix II Edition 5.0.1 Attachment 1 5Non-Content Certificate 5!? @DB/CD2FHG3aLL M}NQ]SHT|UoVBX-YYo\Z]_Yak]d$jV cc PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V-s+&'OOXK;,Sx<%=AZY4ۓ?,hV@qi]|~kCp8sY,Q |m4Y|gF]o@Oݶ7t:KH٣ZxF_ ,"m\L +"HNb\b1y!Q!7^W_ׯ^^./^r&>:_? _~Oo?~\ ZKO_嫗_5U&D9: f JNfbL85*v0 kgG#4KEk8?x9rQkǚW³eg.U guG8u\;^fP5tl?#1é 7~JHvRK))ECLkM2s'֓\rV!9s?#1CT8#9  VqӕTaC"eݜ81zU#J\PyyOG1N:씦q<蘫:w3Dp(qB ]8"DY_>$܉E*%ݩ MYfpW,buZކ/,чxȊ%BUhBoۯR UZ7$6w(cSb4(g܈e19Oꡘq̲Vhn R)yn{{ULߒ*0?SE'p 8'Lx\CbL4v@/|jW3朥av.Xr eDeI2ba3]zmP nI^ zyɩSʵ Ju44K`fzVmV `VY yڿoڊqS^ˆ($GE c V Dm<.vpIY歓ZXr[fl-M.3iŽVSg( EF8ܙU/98 ^o Lda8&:."<Ѕ)qvP>4 0Z4Ŕ`) EX=]B`eO0e7AmlCYvf:x l}t}`i[Nk7vh`w{h8co4 I:6,bmlR x }, {k1rʎ)Z~ˬMԵi_15 [ʋɍ2nqKVG Ip7)f8`%Fa zͶ2/:y̠5,IU$)K7wwj]˳5OR(-jjr!3 PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-! aKI#theme/theme/theme1.xmlPK-! ѐ'S theme/theme/_rels/themeManager.xml.relsPK]N  g2  sȦ  dMbP?_*+%,=&M&d2?'M&d2?(i4F?)M&d2?MF14-H-10- ߁ 4dXA4CanonL`&Canon iR-ADV C5250/5255 LIPSLXddd      d d d d dd    dd@@d  d  d dd d""eddd      !"#$%&'()*+,-./0123456789:;<=>?@ABCd"    @  !"#$%&'()*+,-d.d/d0123456789:;<=>?@ABCDEFGHIJKLMNO"d     d !"#$%&d!dddd!      d dd 8  4 22h 1 4 22h 1Xdd -3 00000\CNZSRGBC.ICC\CNZSRGBC.ICC\CNZSRGBC.ICC r00yyH-3 0fgjn-[X d       #$%&" RXXM&d2?M&d2?&d2U} [}  [}  [} [}  [} [s,,,?@?@?@?@@@ @ w @ @ @@@@@@@,h@ ,@ ,f,f,f,f,f,f,f,f,f \  \  ]8  ]9  ]:  ];  <^ _H `3 =     7       a> b4 ?c~ d? @e~ g@ Ah~ g@ Bh~ g@ Ch~ g@ h~ g@ Dh~ g@ Eh~ g @ Fh~ g"@ GhDl&*"""""......... ,f!Xf"Xf#,f$Xf%X@&,f',@(,@),@*,@+,@,,@-,@.,@/,@0,@1,@2,@3,@4,@5,@6,@7,@8,@9,@ :,@;,@<,@ =,>,?,@ ~ g$@ N h~ !g&@ !M!h~ "g(@ "L"h~ #g*@ #K#h~ $g,@ $J$h~ %g.@ %I%i~ &g0@ &T&h~ 'g1@ 'S'i~ (g2@ (R(i~ )g3@ )Q)h~ *g4@ *P*h~ +g5@ +O+h~ ,g6@ ,Z,h~ -g7@ -Y-h~ .g8@ .X.j~ /g9@ /W/h~ 0g:@ 0V0h~ 1g;@ 11h~ 2g<@ 2U2h~ 3g=@ 3a3h~ 4g>@ 4`4h~ 5g?@ 5_5h~ 6g@@ 6^6h~ 7g@@ 7]7h~ 8gA@ 8\8h~ 9kA@ 9[9l~ :B@ ::~ ;B@ ;;~ <kC@ <<=m =\ =>m>\ ?aDl.............................&@,@ A,@BX@CX@DX@EX@FX@G,@HX@IX@J,@KX@L@M@N@OP@Q@RX@SX@T,U,VX@ W, X(Y*Z/[\, ], ^,_, @n4 @o? @@ @p@q~ Ar? 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