105.针对IOS-MAT-0010聚氨酯海绵的自我声明IOS-MAT-0010_SD_PU

Self declaration for polyurethane foam, according to IOS-MAT-0010

针对IOS-MAT-0010聚氨酯海绵的自我声明

This form-or an equivalent form with the same information shall be used to certify compliance with requirements according to specification IOS-MAT-0010(AA-10911-11).This form is to be signed by the producer of the PU foam material. This can be either the IKEA supplier or a sub-supplier. It is also to be signed by the subsequent link(s) in the supply chain, i.e. the user(s) of the PU foam to make a component or part of article ( when this subsequent user is the IKEA supplier, their signature is not needed).

此文件或具备同等信息的声明文件是针对IOS-MAT-0010(AA-10911-11)的符合性声明，且由聚氨酯海绵生产商签署，海绵生产商有可能是宜家供应商或其下级供应商。签署人还可为供应链上的后续环节，例如，使用聚氨酯海绵制造产品组件或产品的某一部分的生产商（如该后续使用者为宜家供应商，则不需签署）。

The self declaration shall be in English – addition of information in local language is voluntary.

自我声明必须是英文的，以当地语言陈述的附加信息仅作参考。

Supporting documents, verifying fulfillment of the requirements, shall be listed in Table 4, such as:

? Test reports,

?Self declarations or certificates from sub-suppliers of chemical products used to make the PU foam.支持文件，即证实可以满足要求的文件，须列在表4中，比如：

?测试报告

?来自于生产该聚氨酯海绵所需的化学产品的供应商的自我声明或证书。

Note:”Not applicable” shall only be ticked if the material being declared is not in the scope of the requirement according to IOS-MAT-0010.

注：“不适用”仅在被声明材料不属于IOS-MAT-0010要求范围之内时可选。

When referring to chemical substances that are included in lists established by government

authorities, this SD applies to chemical substances that are included in such list at the time of signing.

对引用来自政府制定的法规和标准里面的化学物质清单时，此声明适用于签署时清单里的物质。

2Documentation as required in the approval from IKEA shall be attached to this SD.

作为宜家许可的文件需要附在此声明内。

3“Fulfils(no use)”= No use of any flame retardant or only use of melamine, chalk, graphite, kaolin or

modacrylic fibre.

“满足（未使用）“=没有使用任何阻燃剂或仅使用了三聚氰胺，碳酸钙，石墨，高岭土或改性聚丙烯腈纤维。

4Allowed to be used in upholstery and sofa beds before datestamp 1345 for IKEA sales article

包装周数章为1345周之前的装饰家具及沙发床中允许使用。

This is to certify that we have read and understood IKEA specification IOS-MAT-0010 and that the materials listed in Table 1comply with IKEA requirements according to specification IOS-MAT-0010 (AA-10911-11) .

兹证明我们已阅读及理解宜家技术规范IOS-MAT-0010，且列于表1的材料能够符合宜家技术规范MAT-0010 (AA-10911-11)的相关要求。

Even if this form is signed by a sub-supplier（or sub-sub-supplier, ect） to the IKEA supplier, IOS-MAT-0010 as part of the Purchasing Agreement between IKEA and IKEA supplier always applies, and compliance is the final responsibility of the IKEA supplier in all cases.

即使此文件是由宜家供应商的下级供应商(或下-下级供应商，等)签署，作为宜家和宜家供应商采购协议的一部分IOS-MAT-0010仍然适用，且在任何情况下，满足其要求仍是宜家供应商的最终责任所在。

To be filled in by the final chemical processor(final material producer) of the Polyurethane foam:

由聚氨酯海绵的发泡工厂（最终材料制造商）填写：

Name of final chemical processor

of the Polyurethane foam:

聚氨酯海绵材料的发泡工厂名称：

Address and phone no.(or supplier

number, for IKEA supplier):

联系地址和电话号码（如为宜家供应商，

请提供供应商编号）：

Place and date:

时间和地点:

Name and signature:

姓名（正楷）和签名: