EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1

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1. Instructions
EICC and GeSI members have expressed a commitment to taking steps to enhance social and environmental performance related to the supply chain for minerals used in the products of members companies. This research project will investigate the supply chain for tin, tantalum, and cobalt used in electronics. The purpose is to 1) create a picture of the electronics supply chain for these metals; 2) ascertain whether companies in the supply chain have codes of conduct addressing social, environmental, health, and labor issues; and 3) identify the challenges of collecting this data and consider ways to enhance and maintain transparency of the supply chain. The goal is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms—commercial relationships and terms will be held in confidence. Other Please fill out the information (15+ questions) in this survey and submit at your earliest convenience. If you have questions about this survey, please contact Jennifer Peyser at RESOLVE (jpeyser@resolv.org, +1 202-965-6215). Thank you in advance for your time. For some questions, you will be asked to email documentation (e.g., codes of conduct) to RESOLVE. Please send all documents to Jason Gershowitz at RESOLVE (jgershowitz@resolv.org). For the purposes of this research project we are focused on products made with or containing cobalt that EICC/GeSI members purchase from or supply to you.

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
2. Survey

* 1. Please provide the following information:
Company Name: Company Address: Name of person filling out form: Email address of person filling out form: Phone number of person filling out form: Do you provide recycled cobalt? (Yes/No):

* 2. What type of operation(s) is your company? If you select more than one
operation, please explain. Please note which operation type you would like your company to be classified as in RESOLVE’s supply chain mapping. Current supply chain maps can be found on the EICC-GeSI Project Wiki http://eicc-gesi.resolv.wikispaces.net/Supply+Chain+Visuals
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Other Comptoir Negociant Artisinal Mine Mine

Please note which operation type you would like your company to be classified as in RESOLVE’s supply chain mapping.

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EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
3. Survey: Customer Information
Other

* 3. Customer A: Please fill out all boxes below for one of your customers of
cobalt or materials containing cobalt. The goal of this research is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms - commercial relationships and terms will be held in confidence. Insert “n/a” for customer tiers that do not apply, or where the supply chain ends. Insert the broker company name as the customer, if applicable. Insert a question mark (“?”) for the information that you do not have or cannot obtain. Insert an exclamation point ("!") next to the information that is confidential.
Customer Company Name: Customer Company Headquarters Mailing Address: Customer Point of Contact (Name, phone number, email address): Name of Facility/Mine: Mailing Address of Facility/Mine:

* 4. What type of operation is Customer A?
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Comptoir Negociant Artisinal Mine Mine Other (please specify)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)

* 5. Do you have additional customers of materials that contain cobalt?
j k l m n j k l m n
Yes No

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
4. Survey: Customer Information, Continued
Other

* 6. Customer B: Please fill out all boxes below for one of your customers of
cobalt or materials containing cobalt. The goal of this research is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms - commercial relationships and terms will be held in confidence. Insert “n/a” for customer tiers that do not apply, or where the supply chain ends. Insert the broker company name as the customer, if applicable. Insert a question mark (“?”) for the information that you do not have or cannot obtain. Insert an exclamation point ("!") next to the information that is confidential.
Customer Company Name: Customer Company Headquarters Mailing Address: Customer Point of Contact (Name, phone number, email address): Name of Facility/Mine: Mailing Address of Facility/Mine:

* 7. What type of operation is Customer B?
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Comptoir Negociant Artisinal Mine Mine Other (please specify)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)

* 8. Do you have additional customers of materials that contain cobalt?
j k l m n j k l m n
Yes No

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
5. Survey: Customer Information, Continued

* 9. Customer C: Please fill out all boxes below for one of your customers of
cobalt or materials containing cobalt. The goal of this research is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms - commercial relationships and terms will be held in confidence. Insert “n/a” for customer tiers that do not apply, or where the supply chain ends. Insert the broker company name as the customer, if applicable. Insert a question mark (“?”) for the information that you do not have or cannot obtain. Insert an exclamation point ("!") next to the information that is confidential.
Customer Company Name: Customer Company Headquarters Mailing Address: Customer Point of Contact (Name, phone number, email address): Name of Facility/Mine: Mailing Address of Facility/Mine:

* 10. What type of operation is Customer C?
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Comptoir Negociant Artisinal Mine Mine Other (please specify)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)

* 11. Do you have additional customers of materials that contain cobalt?
j k l m n j k l m n
Yes No

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
6. Survey: Customer Information, Continued

* 12. Customer D: Please fill out all boxes below for one of your customers of
cobalt or materials containing cobalt. The goal of this research is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms - commercial relationships and terms will be held in confidence. Insert “n/a” for customer tiers that do not apply, or where the supply chain ends. Insert the broker company name as the customer, if applicable. Insert a question mark (“?”) for the information that you do not have or cannot obtain. Insert an exclamation point ("!") next to the information that is confidential.
Customer Company Name: Customer Company Headquarters Mailing Address: Customer Point of Contact (Name, phone number, email address): Name of Facility/Mine: Mailing Address of Facility/Mine:

* 13. What type of operation is Customer D?
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Comptoir Negociant Artisinal Mine Mine Other (please specify)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)

* 14. Do you have additional customers of materials that contain cobalt?
j k l m n j k l m n
Yes No

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
7. Survey: Customer Information, Continued

* 15. Customer E: Please fill out all boxes below for one of your customers of
cobalt or materials containing cobalt. The goal of this research is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms - commercial relationships and terms will be held in confidence. Insert “n/a” for customer tiers that do not apply, or where the supply chain ends. Insert the broker company name as the customer, if applicable. Insert a question mark (“?”) for the information that you do not have or cannot obtain. Insert an exclamation point ("!") next to the information that is confidential.
Customer Company Name: Customer Company Headquarters Mailing Address: Customer Point of Contact (Name, phone number, email address): Name of Facility/Mine: Mailing Address of Facility/Mine:

* 16. What type of operation is Customer E?
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Comptoir Negociant Artisinal Mine Mine Other (please specify)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)

* 17. Do you have additional customers of materials that contain cobalt?
j k l m n j k l m n
Yes No

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
8. Survey: Customer Information, Continued

* 18. Customer F: Please fill out all boxes below for one of your customers of
cobalt or materials containing cobalt. The goal of this research is to create a transparent and understandable representation without identifying customer/supplier relationships or business terms - commercial relationships and terms will be held in confidence. Insert “n/a” for customer tiers that do not apply, or where the supply chain ends. Insert the broker company name as the customer, if applicable. Insert a question mark (“?”) for the information that you do not have or cannot obtain. Insert an exclamation point ("!") next to the information that is confidential.
Customer Company Name: Customer Company Headquarters Mailing Address: Customer Point of Contact (Name, phone number, email address): Name of Facility/Mine: Mailing Address of Facility/Mine:

* 19. What type of operation is Customer F?
c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g c d e f g
Component Manufacturer Shaper Refiner Smelter Trader Distributer Comptoir Negociant Artisinal Mine Mine Other (please specify)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
9. Survey, continued

* 20. Are you willing to ask that your customer(s) cooperate with RESOLVE
and EICC/GeSI as we take the next step in this research and request similar information from them?
j k l m n j k l m n
Yes No

21. Please explain or note any questions about contacting your customers:
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EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
10. Survey, continued

* 22. Does your company have a code of conduct, standards or requirements
in place that address human rights, conflict, and environmental, social, economic and/or labor issues? If you have a code of conduct in please, please email a copy to Jason Gershowitz at RESOLVE: jgershowitz@resolv.org.

j k l m n j k l m n

Yes No

If you do not have codes of conduct in place, are you willing to consider putting such a mechanism in place in the future? Please explain.

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23. If, as a member of a trade association you subscribe to any codes of conduct, standards, or requirements on the issues listed above, please note this below and email any relevant documents or resources to Jason Gershowitz at RESOLVE (jgershowitz@resolv.org).
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* 24. Are there any issues of concern on which your company is particularly
focused (e.g., child labor, fair trade, funding conflict, etc.) and would like to address through an assurance mechanism?
j k l m n j k l m n
Yes No

If yes, please describe the issue(s) of concern and the by which your company tracks and verifies the issue(s).

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EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
11. Survey, continued

* 25. Do you require that your customers have such a code of conduct,
standards, or requirements in place?
j k l m n j k l m n
Yes No

If you answered "Yes" to the above question, please email a copy of the code of conduct you require for your customers, or any related documentation to Jason Gershowitz at RESOLVE(jgershowitz@resolv.org), and describe the document(s) below:

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26. Please describe any mechanism(s) (e.g., supplier auditing, corporate social responsibility report, investor report, government reporting) that you institute to provide evidence of customer compliance with these codes of conduct, standards, or requirements, either directly or through a trade association or voluntary initiatives.
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* 27. Are the mechanisms or reports described above publicly available?
j k l m n j k l m n
Yes No

If yes, please describe below how and where the information is accessible to the public. If you answered no, are you willing to consider putting such a mechanism in place in the future? Please explain.

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EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
12. Survey, continued

* 28. Have you undertaken any supply chain audit activities in the past?
j k l m n j k l m n
Yes No

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
13. Survey, continued
29. For past audit activities, please share the following:
Name of audit: Company/Organization that managed the audit: Date(s) of audit:

30. What did your company learn about from past audits?
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EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)
14. Survey - Thank you
Please be sure to send any documentation related to this project to Jason Gershowitz at RESOLVE (jgershowitz@resolv.org). Documents could include: - Your company's code(s) of conduct - Code(s) of conduct you require of your customers - Publicly available reports or audits - Other documents related to human rights, conflict, environmental, social, economic, and labor that describe your company's approach to these issues. Thank you very much for your participation in this survey.

EICC-GeSI Extractives Supply Chain Tracking Study - Cobalt(1)