Control Union Certifications Application form

SMETA

APPLICATION FORM

Sedex Member Ethical Trade Audit (SMETA)

NAME OF COMPANY APPLYING AND LEGAL STATUS ADDRESS OF COMPANY

(Please use full name of company with e.g. Ltd., Inc, (Street, post code, town, province, country, P.O. Box)
SAC, SA, SARL, BV) (Name of the country is mandatory to mention)
SMA SAC Avenida Rene Descartes 191. Urb. Santa Raquel
ATE.

COMPANY’S LEGAL REPRESENTATIVE COMPANY’S CONTACT PERSON

(Name of person and function) (Complete if different from Legal Representative)
Rolmer Malaga Patricia Lozada

TELEPHONE / FAX NUMBER E-MAIL (and/or website)

Patricia.lozada@smasac.com
957226644

Please mark applicable items

SMETA 2 Pillar Audit  Labour Standards,+ Health & Safety+ Additional elements of Entitlement to work + Sub
Contracting and Home working + Environment(shortened)
X SMETA 4 Pillar Audit ( 2 Pillar Audit + Business Practice + Environment)

X Full Initial Audit

Periodic Audit

Does buyer nominate any certification body to conduct SMETA?

YES (if yes, you need to verify whether your buyer accept Control Union audit report or not)
NO

Indicate the buyer(s) you are supplying

SMETA.APPL.F01(05) Control Union Certifications Head office: P.O.Box 161 8000 AD Zwolle, The Netherlands 1/6
Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040 www.controlunion.com/certification
 Control Union Certifications Application form
SMETA

1. Scope of registration: describe below your business activity to be audited and certified:
Somos una empresa dedicada a la fabricación y acabados de Productos de Higiene del hogar, Cosméticos y Alimentos.

2. Agricultural /Processing units

If you are an individual grower, please describe below the activities of all agricultural units.
If you are manufacturing unit, Please describe below the activities of all processing locations.
(Site name address shall be same as per your SEDEX details)

Site Name Site Address Process (-es) Changed, added or

(e.g. Agriculture, Processing, withdrawn (if
storage washing, cutting, applicable)
selection, packing)
Planta Hornos - Av. Hornos Ate Procesos para el acabado de
alimentos productos alimenticios.

Laboratorios PHD - Avenida Rene Descartes ATE Procesos para la fabricación

Cosméticos de PHD y Cosméticos

Plasticos SMASAC Av. Plasticos ATE Procesos para la fabricación

de Plasticos

3. Please describe the location of the production/processing units,

e.g. travel time between the different units, if applicable
Travel time between units, if applicable estimated time needed for travelling from nearest international airport etc.
Todas las sedes se encuentran en el Distrito de ATE Vitarte.

4. Has the project ever been registered, inspected or certified before by another Inspection/Certification
Body?
If YES, please mention: the name of the inspection and/or certification body, year of application, reason of changing
inspection/certification body. Please enclose relevant documents concerning the previous inspection(s)
(SMETA Report, SMETA CAPR..etc.)

SMETA.APPL.F01(05) Control Union Certifications Head office: P.O.Box 161 8000 AD Zwolle, The Netherlands 2/6
Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040 www.controlunion.com/certification
 Control Union Certifications Application form
SMETA

5. Worker Analysis
(Copy this table if you have more sites)
Worker Analysis -
(Excluding Management)

Site Name Local Migrant

………………

Permanent Temporary Agency Permanent Temporary Agency Homeworkers

Worker
numbers –
male

Worker
numbers –
female

Total

Migrant Workers:
Originating Locations/Countries:

Work undertaken by migrant

workers:

Were migrant workers recruited

through an agency?

If yes, is there a contract with the

agency? Provide details of agencies
and contractual arrangements

Percentage of migrant workers in

company provided
accommodation:

SMETA.APPL.F01(05) Control Union Certifications Head office: P.O.Box 161 8000 AD Zwolle, The Netherlands 3/6
Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040 www.controlunion.com/certification
 Control Union Certifications Application form
SMETA

6. Subcontractors:
Are any subcontractor involved in the scope you applied for?
If yes, please mention: name of subcontractor, address and its activity.

7. Language usage: please describe languages spoken by personnel at the facility?

List of languages spoken Number of personnel for each language

8. Social Relevance of the organisation

Please describe social impacts that can be presence in following areas:

 In child labor and forced labor issues;

 In health and safety issues;

 In freedom of association and right to collective bargaining issues;

 In discriminative issues;

 In disciplinary practices;

 In working hours and wages issues;

 What are the applicable regulatory standards related to your industry;

 Is there any significant problem/complaint in recent past relevant to social impact?

SMETA.APPL.F01(05) Control Union Certifications Head office: P.O.Box 161 8000 AD Zwolle, The Netherlands 4/6
Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040 www.controlunion.com/certification
 Control Union Certifications Application form
SMETA

Undersigned declares to have completed this application form truthfully.

NAME OF COMPANY

LEGAL REPRESENTATIVE

FUNCTION WITHIN COMPANY

DATE & SIGNATURE

Based on the above information, Control Union Certifications will draw up a no-obligation offer for a
contract.

SMETA.APPL.F01(05) Control Union Certifications Head office: P.O.Box 161 8000 AD Zwolle, The Netherlands 5/6
Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040 www.controlunion.com/certification
Reserved for Control Union Certifications : Offer review:

Are the pieces of information provided by this form sufficient for

making up an offer (Form to be duly filled in and signed by the company YES/NO
applying for Certification)?

Available auditor(s) and qualified for auditing the activities YES/NO

Independence and impartiality regarding the auditors and regarding YES/NO

Control Union Certifications?

Conclusion: Can an offer be sent for this project? (Yes if there is no negative answer to
questions)

Evaluation by : Date:

Please type, no handwriting. Ensure that all information is supplied.

TNCF030b TNC Option 2 Quotation Form Page 6 of 1 Issue 1 April 04