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Skapat av (Efternamn Förnamn, org)
Dokumentdatum
Ev. ärendenummer
[Skapat av NY]
[Dokumentdatum NY]
[Ärendenummer NY]
Dokumenttitel
Supplier certificate regarding hazardous substances in materials or
articles
Product name:
Supplier:
Article- or item number* issued by the Swedish Transport
Administration:
* Enter articlenumber if the certificate refers to a single article. If the certificate refers to several articles enter the
item number.
The properties criteria1 shall be applied on each part of a complex article, i.e. the weight of the hazardous
substance is to be divided by the weight of each separate material or article in a complex article.2
1. Does the material/article contain any substance listed on the Swedish Transport
Administration (Trafikverket) list of forbidden materials?
Yes☐
No☐
2. Does the material/article contain any substance listed on the candidate list (according to
the REACH-regulation) in more than 0,1% (w/w)?
Yes☐
No☐
Last review date for the candidate list: ____________________________
If yes, declare which substance on the candidate list the material/article contains in more than 0,1% (w/w)
Name (substance)
CAS no
Content w/w%
Part of complex article*
TMALL 0194 Leverantörsintyg ver. 1.0
*If the product is a complex article - declare in which part of the product the substance is found.
1. More information about the Swedish Transport Administration requirements regarding hazardous substances in materials or
articles, http://www.trafikverket.se/Foretag/Bygga-och-underhalla/Material-och-kemiska-produkter/Farliga-amnen-i-material-ochvaror/. Swedish Transport Administration requirements is harmonised with BASTA properties criteria. Find out more information
about BASTA on www.bastaonline.se.
2.The Swedish Transport Adminitration's requirements regarding complex articles comes from the principle ”once an article
always an article” which is supported by Sweden amongst other European countries including Denmark, France and Germany.
Through the verdict C-106/14 from 10th September, the European court declares that each part of a complex article should be
counted as it's own article. Sweden and The Swedish Transport Administration support this. The content limit for the substances
in the BASTA/BETA and on the candidate list shall be applied on each part of a complex article. More information can be found
at the Swedish Chemicals Agency.
http://www.kemi.se/Documents/Forfattningar/Reach/Vagledning_for_leverantorer_av_varor_SV.pdf?epslanguage=sv
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Skapat av (Efternamn, Förnamn, org)
Dokumentdatum
Ev. ärendenummer
[Skapat av NY]
[Dokumentdatum NY]
[Ärendenummer NY]
3. The material/article meets the properties criteria of the BASTA system:
Yes☐
No☐
If no, specify which (BASTA) properties criteria that the material/article does not meet, together with name of
substance, CAS number and percentage.
BASTA
criterion
No:
No:
No:
Name (substance)
CAS no
Content w/w%
Part of complex
article*
*If the article is a complex article - declare in which part of the article the substance is found.
4. The material/article meets the properties criteria of the BETA system:
Yes☐
No☐
If no, specify which (BETA) properties criteria that the material/article does not meet, together with name of
substance, CAS number and percentage.
BASTA
criterion
No:
No:
No:
Name (substance)
CAS no
Content w/w%
Part of complex
article*
*If the article is a complex article - declare in which part of the article the substance is found
5. The properties criteria are meet through:
☐ Registration in BASTA
☐ Registration in BETA
TMALL 0194 Leverantörsintyg ver. 1.0
☐ Assessment through other available assessment systems. Specify which system:
_______________________________________________________________________
☐ Assessment by supplier (Assessment documentation/sub-supplier declaration is to be
presented at an audit.)
☐ The content of hazardous substances in material or articles according to the Swedish Transport
Administrations criteria can not be verified for all of the components in a material or article, more
information will be submitted in appendix 1.
Signature (responsible for verification):
Place and date:
Name:
Phone/E-mail:
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Skapat av (Efternamn, Förnamn, org)
Dokumentdatum
Ev. ärendenummer
[Skapat av NY]
[Dokumentdatum NY]
[Ärendenummer NY]
Appendix 1
Appendix 1 is only to be answered if the content of hazardous substances not can be verified
for all of the components in a material or article.
6a. Specify the substances in the material/article and how these meet the The Swedish
Transport Administration’s requirements regarding hazardous substances in material or
articles.
Part of complex
article
Name
Meets the properties
criteria of BASTA
(Yes/No*)
Meets the properties
criteria of BETA
(Yes/No*)
Content can not be
verified
* If a part of a complex article does not meet the properties of the BASTA/BETA criteria specify with information
about:
BASTA/BETAproperties that
not meet the
criteria
No:
No:
No:
Name (substance)
CAS no
Content w/w%
The properties criteria are meet through:
☐ Registration in BASTA
TMALL 0194 Leverantörsintyg ver. 1.0
☐ Registration in BETA
☐ Assessment through other available assessment systems. Specify which system:
_______________________________________________________________________
☐ Assessment by supplier (Assessment documentation/sub-supplier declaration is to be
presented at an audit.)
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Skapat av (Efternamn, Förnamn, org)
Dokumentdatum
Ev. ärendenummer
[Skapat av NY]
[Dokumentdatum NY]
[Ärendenummer NY]
6b. Specify in the chart below the percentage of contents in the article or complex article that
can be verified.
Content in the complex article
25%
25%
25%
25%
A - BASTA or assessment through other
available assessment systems (BVB,
SHMD)
B - BETA or assessment through other
available assessment systems (BVB,
SHMD)
C - PHASE OUT does not meet the
properties of the BASTA/BETA criteria
C - UNKNOWN contents
6c. Specify how the information about contents in the complex article has been verified.
__________________________________________________________________________
__________________________________________________________________________
7. Comments:
TMALL 0194 Leverantörsintyg ver. 1.0
__________________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________