To C&A Buying (Quality & Safety Management)

I {insert name here}holding the position of {Insert Position here}and the representative of{Insert Company
Namehere + Company number} do hereby declare that;

Order Number: -

Produced between the dates of: - and

In our approved C&a Production Unit
PU Name: -
PU Address: -
Has been duly checked at all stages of production (sample through to final Inspection) to guarantee that all
required safety requirementsstipulated in the C&A Supplier Quality Manual (chapter Product Safety
Requirements)have been complied with, such as (if attached to the style in question),

1. Buttons attached with Lockstitch only incl. a contrast colored bobbin thread and meet the pull test
requirement
2. Press fasteners are from a nominated C&A source (Prym-Fiocchi/YKK-Stocko/Morito) and were
attached to the garment using the pinch settings provided in the safety data sheet by the nominated
fastener supplier. A copy of the safety data sheet and the C&A “In Line pull testing report” to be
submitted to Quality &Development Management (QAD), C&A Buying, Dusseldorf or Brussels for code
900 (Savis) process.
3. Rivets and eyelets and other components attached to the garment have been checked during
production in line with the C&A requirements and documented in the C&A Production Safety Control
Sheet (In Line pull testing report) to be submitted to Quality &Development Management (QAD), C&A
Buying, Dusseldorf or Brussels for code 900 (Savis) process.
4. Where C&A nominate the source of a component (e.g. zips, rivets, and press fasteners) only those
components from the nominated sources declared at sample approval have been used.
5. All the required safety tests have been conducted onthe product. Samples taken from bulk, tested at a
nominated C&A Laboratory and a pass reportis available.
6. All productshave been passed through a metal detector that was correctly calibrated every two hours
and with no metal being detected in any of the packed products. A copy of the C&A “In Line Metal
Detection Report” to be submitted to Quality &Development Management (QAD),C&A Buying,
Brussels (sa.bru@canda.com) or Dusseldorf (sa.dus@canda.com) for code 900 (Savis) process.
7. A piece by Piece inspection has taken place on all packed productsto ensure correct attachment of
accessories, cord and draw string lengths are in line with the legal requirements etc.
8. All other requirements that are relevant to the style in question and detailed in the “C&ASupplier
Quality Manual”. The most recent copy can be downloaded from the GIN site.

Signed: -

Position: -

Date: -