AIB-VINÇOTTE International s.a. / n.v.
SAFETY, QUALITY, ENVIRONMENT
Member of the Group AIB-VINÇOTTE - VAT: BE 0462.513.222
Head office : Boulevard A. Reyers 80 - B-1030 Brussels
_____________________________________________________
VINÇOTTE - CERTEST PRODUCTS
Everest - Leuvensesteenweg 248 / B-1800 Vilvoorde
Tel. : +32(0)2 674.57.50 - Fax : +32(0)2 674.57.85
E-Mail : okbiobased@vincotte.be
OK BIOBASED - APPLICATION FORM
FOR CERTIFICATION OF
MATERIALS, INTERMEDIATES, ADDITIVES OR PRODUCTS
APPLICANT ( requested for drawing up the contract between Vinçotte and the Applicant )
A. Contact details
 My company is already registered and my contact data have not changed:
Licensee code (S-code):
 My company is not registered yet or my contact data have changed:
Invoice address1:
Company name:
Address Street
ZIP Code, City
Country
Contact Person
Phone
Fax
E-mail
B. Application
Status of the applicant :
Application for:
(see also page 2)
 Manufacturer
 Basic Material
 Importer / Representative
 Component/constituent
 OK biobased
 Finished product
With designation (trade mark, production code) :
Number of different production sites:
Manufacturer(s) / production site(s):
Certified true and complete by :
Name :
Position in the company :
Date:
1
Certification requested for :
Signature :
Only fill in when the invoice address differs from the applicant address
Page 2 / 4
INFORMATION (to be published on the certificate and/or website after awarding of certificate)
On Certificate
and website
Company name:
Address
Street
ZIP Code
Country
Product description :
See table « product family » here after
Trade mark :
On website
only
“Public” Contact Person
Phone
Fax
E-mail
Web site
PRODUCT FAMILY
Please, tick the family of product you ask the certification for :
1.
2.
Raw materials
Components
& constituents
1.1. Bio Material
1.9. Other :
2.1. Films, Sheets & Plates
2.2. Ink, Colorant, Adhesive
& Additives
2.3. Packaging - Miscellaneous
components
3.
Finished products
2.9. Other :
3.1. Bags / Sack trade
3.2. Catering
3.3. Packaging
3.4. Garden, horticultural &
agricultural products
3.9. Other :
1.1.1
1.1.2.
1.9.1.
2.1.1.
2.1.2.
2.1.3.
2.2.1.
2.2.2.
2.2.3.
2.2.4.
2.2.5.
2.3.1.
2.3.2.
2.3.3.
2.3.4.
2.9.1.
3.1.1.
3.1.2.
3.2.1.
3.2.2.
3.2.3.
3.3.1.
3.3.2.
3.3.6.
3.3.7.
3.4.1.
3.4.2.
3.4.3.
3.9.1.
In form of Resin or Granulates
In form of Film
Description :
Bio-material
Natural Material
Paper
Additive
Adhesive
Colorant
Ink for printing
Masterbatch
Badle wrap
Printed Paper Labels
Lid
Tube
Description :
Bags for collection of biodegr. refuse
Shopping bags
Trays & Plates
Cup
Cutlery
Food packaging – Rigid
Food Packaging – Flex
Non-Food Packaging – Rigid
Non-Food Packaging – Flex
Clippers
Films (mulching )
Plants pots
Description :
All the provided information will be treated as highly confidential
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Page 3 / 4
PRODUCT DATA :
Please, fill in the form carefully! The more accurate the form is filled in, the easier and faster the treatment!
A. USED MATERIALS (INCLUDING ADDITIVES, INKS, MASTERBATCHES, FILLERS, …)
Supplier of the material
Organic
Biobased
carbon
carbon
content
content
(%)
(%)
(Only fill in when known)
Organic or
Inorganic?
Org./Inorg.
Org./Inorg.
Org./Inorg.
Org./Inorg.
fill in case of FINISHED PRODUCTS or COMPONENTS & CONSTITUENTS
fill in case of RAW MATERIALS2
Reference name or code of the material
Percentage in
total product by
dry mass (%)
Org./Inorg.
Org./Inorg.
Org./Inorg.
Org./Inorg.
Org./Inorg.
Org./Inorg.
B. DIMENSIONS
Description of relevant dimensions (length, width, … ) of each component of the product
Value
C. SPECIFICATIONS AND/OR REMARKS
(e.g. composition of the different components, variations, use of foaming gaz …)
…………………………………………………………………………………………………………...
…………………………………………………………………………………………………………...
…………………………………………………………………………………………………………...
…………………………………………………………………………………………………………...
…………………………………………………………………………………………………………...
D. CARBONATE CONTENT
Does the product contains Calcium Carbonate (CaCO3)?
 Yes: …………. %
 No
 I don’t know
2
For confidentiality reasons, the information about the used materials in case of application for certification of raw
materials can also be provided later during the certification process.
All the provided information will be treated as highly confidential
Page 4 / 4
PLEASE ATTACH :

Samples representative for the products to certify

Drawing (and photos – if helpful) of the product (in case of finished product)
All the provided information will be treated as highly confidential