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SUPPLIER DETAILS AND DECLARATION: By signing (or submitting electronically) I declare all information provided is true and correct. Company Name

Phone

Authorised Officer

Email

Position

2013 TIMBER & WOOD PRODUCT SURVEY FORM

Signed

Date

Please complete one form for each product group supply chain. If a product group comes from multiple supply chains, complete one form for each supply chain. Product Group (Select one)

 Chipboard  Firewood  Mouldings

 Component Product  Garden Furniture  Plywood

 Decking  Joinery  Sawn Timber

 Doors  Laminate Flooring  Solid Timber Flooring

Product Description (Provide a short description)

Product’s Timber Composition (Select one)

 Native

If a Plantation, Plantation Conversion Date (Select one)

 Plantation

 November 1994 or before

 Whole-Wood

 after November 1994

 Not 100% from

 100% from

 100% from

 100% from

 100% from

 100% Re-used

 Other,

recycled/waste

pruning

harvest waste

mill waste

factory waste

Post-Consumer

Please Specify:

Risk Category (Use Risk Matrix to select one)

 VH

Estimated Sales to Bunnings AUD$ Value (Ex. GST)

$

Type of Certification (Select one)

 Component

State/Region/ Province of Harvest

Country of Harvest

Is your product 100% from recycled/waste materials?

 Flat-Pack Furniture  MDF

Please provide botanical name or common name of timber species. General terms such as ‘hardwood’ will not be accepted.

Species Name

Type of Forest (Select one)

 Dressed Timber  Manufactured Whole Timber

 HH

H

M

 L  VL

NOTE: VH products will not be accepted; HH products are required to forward a copy of certification to [email protected]; H risk products are required to be Certified Responsibly Sourced. M risk products will be required to be Certified Responsibly Sourced by end 2013. L products required to commit to transitioning to Certified Responsibly Sourced by end 2015. Complete item below.

Estimated Sales to Bunnings in cubic metres (m3)

 3rd Party Certification

______________________________________

 Government Permit/Approval

m3

NOTE: include ONLY the part of the product that is timber

 Other, Please Specify:

rd

3 Party Cert. Scheme or Government Department Name

Issued To

Document Number

Expiry Date

Is your product marked with a 3rd party certification logo? L risk product commitment (Select one if L risk product) Does this product meet documentation benchmarks?

 Yes

 No

 This product is already Certified Responsibly Sourced.

 We commit to transitioning towards 3rd party Certified Responsibly Sourced by end 2015.

 Yes



 No

If NO, complete an ACTION PLAN

Action Plan for HH/H risk product completed.



Action Plan for M risk product completed.