ELV-AUTOMOTIVE CHEMICAL TESTING APPLICATION NUMBER

SGS (Thailand) Limited - E&E Laboratory services : 700/693 Moo 7 T. Don Hua Roh, A. Muang, Chonburi 20000 Thailand
t +66(0)33 266 165 f +66(0)33 266 166 e lab.thailand@sgs.com (Please find the General Conditions of service specified herein or www.sgs.com)
APPLICANT INFORMATION (ชือ่ บริษทั /ทีอ่ ยูท่ ใ่ี ช้ในการออกใบรายงานผลวิเคราะห์และชือ่ ผูส้ ่งตัวอย่างภาษาอังกฤษ) SGS REFERENCE:
Company Name : YAWATA Electrode (Thailand) Co., Ltd.
Address : 82 Moo 5, Kamtalesor-Khoksung Road, Tambon Kamtalesor, Aumphur Kamtalesor, Nakhonratchasima 30280 Thailand
Contact Name : Takul Thongyoo Tel. 084 645 5264 Email: takul@yawata.co.th
BILL TO INFORMATION (ชือ่ บริษทั /ทีอ่ ยูแ่ ละผูต้ ดิ ต่อสาหรับการออกใบแจ้งหนี้ /ใบเสร็จรับเงินและใบกากับภาษีภาษาอังกฤษ)
Bill to company : YAWATA Electrode (Thailand) Co., Ltd.
Bill to address : 82 Moo 5 Tambon Kamtalesor, Aumphur Kamtalesor, Nakhonratchasima 30280 Thailand
Contact Name : Takul Thongyoo Tel. 084 645 5264 Email: takul@yawata.co.th
Please attach the purchase order when you submit the sample, if any (กรุณาแนบใบสั ่งซือ ้ ทีต่ อ้ งการอ้างอิงบนใบแจ้งหนี้พร้อมกับการส่งตัวอย่าง ถ้ามี)
PLEASE FILL THE SAMPLE IDENTIFIED AS FOLLOWS (กรุณากรอกข้อมูลด้านล่างนี้ เป็ นภาษาอังกฤษเพื่อใช้แสดงบนใบรายงาน) :
Product/Sample Name (ชือ
่ ตัวอย่าง): YAWATA YM-70S-G Sample Description (ลักษณะตัวอย่าง): METAL
Batch/Lot No: Part No: Buyer:
Manufacturer/Vendor: Country of origin: Country of destination:
Material Type: No.of sample submitted: Ref.Quotation (อ้างอิงเลขทีใ่ บเสนอราคา) LB
Product information Test (s) required : Please check mark appropriated box(es)
Metal without plating (โลหะที่ไม่มีการชุบเคลือบ) Group tests (รายการวิเคราะห์แบบกลุ่ม)
Metal with plating (โลหะชุบเคลือบ) Heavy metal 4 items (ต้องการวิเคราะห์โลหะหนักทั้ง 4 รายการ)
Plastic (พลาสติก) Type/ชนิด : Lead (Pb), Cadmium (Cd), Mercury (Hg) and Hexavalent Chromium (Cr6+) - IEC method
Rubber (ยาง) Heavy metal & Flam Retardant 6 items (ต้องการวิเคราะห์โลหะหนักและสารหน่วงการติดไฟ ทั้ง 6 รายการ)
PVC (พีวีซ)ี : Lead, Cadmium, Mercury, Hexavalent Chromium, PBBs, and PBDEs - IEC method
Silicone Rubber (ซิลโิ คน) SOC 10 items: (ต้องการวิเคราะห์ 10 สาร SOC)
Tape & Adhesive (เทปกาว) : Pb, Cd, Hg, Cr6+, PBBs, PBDEs,Deca BDE, HBCDD, PFOS and Abestos
Ink / Paint (หมึกหรือสี ) Heavy metal, Flam Retardant & Phthalate 10 items
Fabric, Leather (ผ้า, หนัง) : Pb, Cd, Hg, Cr6+, PBBs, PBDEs,Deca BDE, Phthalate (BBP, DBP, DEHP, DIBP)
Paper and paper cardboard (กระดาษ) Individual test tiems (รายการวิเคราะห์ที่ต้องการ)
Chemical solution (ตัวอย่างประเภทสารเคมี โปรดระบุชนิด) Hexavalent Chromium (Cr6+) in metal/metal with plating (การทดสอบCr6+ ในโลหะโปรดระบุวิธีการทดสอบ)
Acid (กรด) Alkali (ด่าง) Solvent IEC Required sample size 200 cm2 (ต้องการปริมาณตัวอย่างเป็นพื้นที่ 200 ตารางเซนติเมตร)

Required MSDS (Material Safety Data Sheet) Other method (please specify ต้องการทดสอบวิธีการอืน
่ ๆ โปรดระบุ )

สาหรับตัวอย่างประเภทสารเคมีกรุณาแนบ MSDS มาพร้อมกับ Halogen free - BS EN 14582 Method

ตัวอย่างทุกครั้ง ขอสงวนสิทธิ์ที่จะไม่ดาเนินการทดสอบกรณีไม่มี Bromine (Br) Chlorine (Cl) Fluorine (F) Iodine (I)
เอกสาร MSDS Flam Retardant (ลูกค้าต้องการทดสอบสารหน่วงไฟ) Method IEC62321

Other Product (ตัวอย่างประเภทอืน

่ ๆ และตัวอย่างมี Polybrominated biphenyls (PBBs) Polybrominated diphenylethers (PBDEs)
ส่วนประกอบมากกว่าหนึ่ง โปรดชี้แจงรายละเอียดส่วนประกอบ Phthalate : BBP, DBP, DEHP, DIBP (ทดสอบ Phthalate 4 รายการ โปรดระบุวิธีการที่ตอ
้ งการ)
ของสินค้าเพื่อประกอบการพิจารณาการทดสอบ) IEC62321 EN14372 Other
Other Heavy metal (ต้องการทดสอบโลหะหนักโดยวิธีการอืน
่ ๆ โปรดระบุ )
Sample size
ปริมาณตัวอย่างที่ตอ
้ งการอย่างน้อย 30 g หรือ 30 ml XRF screening test (ลูกค้าต้องการวิเคราะห์โลหะหนักเบือ
้ งต้นแบบ Screening)
ยกเว้นหมึกพิมพ์หรือสี ต้องการตัวอย่างอย่างน้อย 150 g : Cadmium, Lead, Mercury, Bromine, Chromium
Other tests & method, please specify (กรณีลูกค้าต้องการวิเคราะห์รายการและวิธีการอื่นๆ
Asbestos Method Other tests(รายการวิเคราะห์อื่น ที่ไม่มีระบุไว้ข้างต้น)
Remark for Special Instruction:
DMF Method
PCB Method
PAHs 15 items Method
HBCDD Method
HCB Method
PFOS Method
PFOA Method
SVHC …........... Items

1. Issue Test Report by One report per sample Separate report by Note: If client does not specify this part, we will issue report per sample.
2. Services Required: Regular service Express service (3 working days:40%surcharge) Double express service (1 working day :80%surcharge)
3. Sample after tested: Dispose sample Return Residual Sample (30 days after report date)
4. Document Delivery: Applicant Address Bill to Address Received by client
Require conclusion on test report : Yes, please consider decision rules as below* Not require
Simple Acceptance (Judgement with standard spec up to Risk level 50%)
Guard Bands with binary statement (Judgement with standard spec + MU and Risk level 2.5%)
“ลูกค้า และหรือผู้ตด
ิ ต่อในใบสั่งงานฉบับนี้ยอมรับว่าข้อมูลใดๆ ที่ระบุให้ไว้ในใบสั่งงาน (Application Form) ฉบับนี้ เป็นข้อมูลที่แท้จริง และถูกต้องตามกฏหมาย หากปรากฏว่าข้อมูลดังกล่าวก่อให้เกิดความ
เสียหายใดๆ กับบุคคลอืน
่ ในภายหลังลูกค้า และหรือผู้ตด
ิ ต่อที่เป็นผู้ให้ข้อมูลในใบสั่งงานฉบับนี้ยอมรับผิดในความเสียหายที่เกิดขึ้นกับบุคคลอืน
่ และเอสจีเอสทั้งหมด /Customer and/or Contact person
specified on this Work Order agrees that any information being provided as customer information and specified on the Application Form is legitimate and true. If it becomes apparent
that the provided information subsequently causes any damage to a third party, the customer and/or the contact person who provides information on this Application Form agrees to be
liable to a third party and SGS for all damage arising in connection with the information provided.”
ลายมือชือ ่ ผูส ่ ต ัวอย่าง
้ ง Received / Checked by SGS Staff:
Signature Date 9-Aug-23 Signature Date

All testing will be carried out subject to SGS (Thailand)'s conditions of testing. SGS Form No.LBAD-19002, Rev.3, Dated 26/9/2022
All testing will be carried out subject to SGS (Thailand)'s conditions of testing. SGS Form No.LBAD-19002, Rev.3, Dated 26/9/2022
 CONFIDENTIAL INFORMATION
1. As used in this form, confidential information” (hereinafter "Confidential Information") shall mean and encompass any
information, material, computer programs, specifications, software, know-how and data, of a technical, commercial, financial, marketing
or any other nature, disclosed or submitted to either party (hereinafter, the "Receiving Party") by or on behalf of the other party
(hereinafter the "Disclosing Party") during the performance of services or prior thereto in relation to the purpose specified in the preamble:

(i) in writing and marked “confidential” by the Disclosing Party; or

(ii) by drawings, models, prototypes, photographs, software programs or in any machine readable form, which information is
stated by the Disclosing Party to be confidential; or

(iii) orally, and identified in writing as confidential by the Disclosing Party within 15 (fifteen) days from disclosure; provided,
however, that the parties acknowledge that it may be impractical and inefficient to record in writing information informally divulged
in the ordinary course of business relationships, but nevertheless undertake and agree to use their best efforts to treat such
information as Confidential Information hereunder to the extent that it is recognisable in good faith as proprietary confidential
information of the Disclosing Party.

Confidential Information shall also include, without limitation, the content and existence of services and of the relationship created
between the Parties hereby.

2. From the date first written above and for a period of 1 (one) year after the completion of services, each party shall (i) keep
the Confidential Information received from the other party confidential; (ii) not use it for any other purpose than that specified in the
preamble; (iii) not disclose it, and (iv) prevent its disclosure to, or use by, others. Each party shall further only make the Confidential
Information available to its employees, professional advisors or third party consultants, to the extent that they require knowledge thereof
for the purpose specified in the preamble and provided that, with respect to the Confidential Information, any such employee,
professional advisor or third party consultant is bound by obligations of secrecy and limited use at least to the same degree that the
Parties are bound hereunder, and provided further that each such employee, professional advisor or third party consultant shall, before
any Confidential Information received from the other party is made available to him, be notified by the party employing him of the
confidential nature thereof.

3. The Receiving Party shall take all reasonable steps to ensure that the Confidential Information received from the other party
is securely held. Each party shall be answerable for any unauthorised disclosure or use of the Confidential Information by its employees.

4. The obligations of confidentiality and limited use set forth herein shall not apply to the extent that Confidential Information:

(i) was known by the Receiving Party from sources other than the Disclosing Party prior to receipt as is documented in written
records possessed by the said party prior to such time; or

(ii) is at the time of disclosure to the Receiving Party in the public domain or subsequently becomes part of the public domain
without a breach of its confidentiality obligations hereunder by the Receiving Party; or

(iii) is disclosed to the Receiving Party by a third party without any obligation of secrecy to the Disclosing Party, of which the
Receiving Party is aware; or

(iv) is disclosed by the Disclosing Party on a non-confidential basis to any third party; or

(v) is independently developed by employees of the Receiving Party who have not had access to the Confidential Information
disclosed by the Disclosing Party; or

(vi) is removed from confidential status or cleared for disclosure to a third party by prior written consent of a duly authorised
officer of the Disclosing Party, subject to any conditions which may be provided for at the time of such removal or clearance.

Specific information shall not be deemed to be within the exceptions listed above merely because it is embraced by more general
information within such exceptions, nor shall a combination of features be deemed within such exceptions merely because the individual
features of such combination are within such exceptions.

5. It is understood by the Parties that the Confidential Information may relate to products or processes that are under
development or planned for development. Neither party makes warranties regarding the accuracy of such Confidential Information or
accepts responsibility for any expenses, losses, or action incurred or undertaken by the other party as a result of the receipt thereof. It
is further understood that the disclosure of such Confidential Information does not warrant the introduction of any product or process to
which the Confidential Information disclosed is related.

6. No right, title or interest in, or license to, any patents, trade secrets, copyrights, or other intellectual property of the other
party is granted or conveyed by either of the Parties to the other.

7. Neither party has any obligation to supply Confidential Information hereunder, nor does this Agreement represent any
commitment by either party to enter into any future agreement with the other.

8. The Parties agree that all documents, drawings, designs, models or other information in written or tangible form containing
or embodying the Confidential Information shall be and remain the property of the Disclosing Party. Neither party shall copy, duplicate
or otherwise reproduce any documents containing all or any parts of the Confidential Information without the prior written consent of the
other party. Each party agrees, within 10 days from the other party’s request, to return to the other party or, if so requested, destroy, all
Confidential Information in tangible form received from it and any copies made thereof, and to erase any copies in machine-readable
form, provided that either party may retain copies of Confidential Information to the extent required by law and always subject to the
terms and conditions of this form.

9. No waiver by either party of any breach of any condition of these confidentiality provisions shall be construed as a waiver of
any subsequent breach, whether of the same or of any other condition of the provisions.

10. In the event that one of the Parties, or anyone to whom Confidential Information is disclosed pursuant to this form is or
becomes legally required or compelled to disclose any of the Confidential Information, such party shall provide the other party with
prompt notice so that such other party may seek a protective order or other appropriate remedy and/or waive compliance with the
provisions of this Article. In the event that such protective order or other remedy is not sought or obtained or in the event that the other
party waives compliance with the provisions of this Article, the compelled party will furnish only that portion of the Confidential Information

All testing will be carried out subject to SGS (Thailand)'s conditions of testing. SGS Form No.LBAD-19002, Rev.3, Dated 26/9/2022