IV. Requests to suppliers

The suppliers are kindly requested to promote environmental preservation activity systematically and to realize improvement continually. For this purpose, please respond to us for the survey on the following items related to the improvement activities of the supplier and the procurement goods.

1. The report to be submitted

(1) The report is composed of the following forms. Please submit it to the relevant department.

1. Example 1 <Form 1> (PDF:81KB)
   Evaluation of environment preservation by the supplier
   
2. Example 2 <Form 2> (PDF:75KB)
   Certification of non-inclusion of prohibited substance (Rank A)
   
3. Example 3 <Form 3> (PDF:91KB)
   Report on prohibited delivery term of regulated substitutional substances (Rank A’)
   
4. Example 4 <Form 4> (PDF:96KB)
   Report on the activity to create environmentaly harmonized product

(2) Return method

Fill in the blank of the relevant documents (Form 1, 2, 3 and 4), sign and submit them to KITASHIBA.

(3) Confidentiality

The submitted report is kept secret and is not disclosed.

2. Term of survey

(1) The suppliers are regularly requested to submit the report on the survey on their environmental preservation activity by the specified date by the relevant department of KITASHIBA (once in 3 years).

However, the supplier will be asked timely if it submitted the report on delivery prohibited term of regulatory substitutional substance (rank A’).

3. How to fill in the blank

Please refer to the examples indicated above Form 1, 2, 3 and 4.

* Reference material: The Guidelines was prepared referring to Green Procurement Guidelines of Toshiba Corporation.

Contact: Please contact with our department that requested the survey when asking questions.

KITASHIBA ELECTRIC CO.,LTD.
Procurement Dept	Small Motor Company
TEL: +81 24 537 2225 FAX: +81 24 537 2138	TEL: +81 24 537 2198 FAX: +81 24 537 2190