Supplier self-declaration

Receiver*

General Information

Company name:*

Address (PO Box):

Address (Street):*

Town/Postal code:*

Country:*

Phone:*

Fax:*

Homepage (Internet):*

Name of person completing the form:*

E-mail address of person completing the form:*

Contact Details

General Manager:

Phone/Fax:

Mobile:

E-mail:

Production:

Phone/Fax:

Mobile:

E-mail:

Quality:

Phone/Fax:

Mobile:

E-mail:

Engineering:

Phone/Fax:

Mobile:

E-mail:

Logistics:

Phone/Fax:

Mobile:

E-mail:

Sales:

Phone/Fax:

Mobile:

E-mail:

Company Details

Ownership structure:

Private Public

DUNS:*

Vat Id. No.:*

Parent company:

Other locations:

Asset value in €k:

Annual revenue in €k:

Current year -2:

Current year -1:

Current year:

Purchasing volume in €k:

Current year -2:

Current year -1:

Current year:

Number of employees:

Total:

Production:

Quality:

Development:

Production Details

Product type:

Main products in % of total production:

Shift systems:
(e.g. 8h/shift; 3 shifts/day; 6 days/week)

Engineering

Do you have in-house tool engineering and manufacturing?

Yes No

Comment

Are you capable of producing prototypes?

Yes No

Comment

Do you have a CAD system/systems?

Yes No

Comment

Do you have a lab with suitable measuring and test equipment?

Yes No

Comment

Quality

Are you ISO9001/2015 certified?*

Yes No

Comment

Do you have product liability insurance?*

Yes No

Comment

Scope of insurance policy

Logistics

Do you have an ERP system?

Yes No

Comment

Do you have EDI? Please specify service provider:

Yes No

Comment

Do you have video conferencing capabilities?

Yes No

Comment

Do you use a freight consolidator?

Yes No

Comment

Main types of transport:

Rail Road Sea Air

Environment

Do you have an environmental strategy/policy?

Yes No

Comment

Are you ISO14001 certified?

Yes No

Comment

Are you ISO 50001 certified?

Yes No

Comment

Acceptance of SIMONA Standard Terms and Conditions

Payment terms 14 days/3% deduction - 30 days/No deduction*

Yes No

Comment

Acceptance of *

Yes No

Comment

Acceptance of Data Protection Statement

I have read the and accept it.*