COMPANY LEGAL TITLE (*)

ADDRESS (*)

PHONE NUMBER (*)

FAKS NUMBER (*)

WEBSITE (*)

E-MAIL (*)

TRADE REGISTRY (*)

TRADE REGISTRY NO (*)

TAX ADMINISTRATION (*)

Vergi No/T.C Kimlik No (*)

Ticaret Sicil/Mersis No (*)

Kep Adresi (*)

Company Partnership Structure (*)

Affiliates (*)

Sahip Olunan CERTIFICATIONS
(Copies of the certificates must be submitted with this form)

ISO 9001: 2015ISO 14001ISO 13485: 2016GMPCEISO 27001TSEOther

Other Certifications

CUSTOMER

Name-Surname (*)

Title (*)

Phone (*)

AUTHORIZED PERSON WITH ACCOUNTING

Name-Surname (*)

Title (*)

Phone (*)

LOGISTICS AUTHORIZED PERSON

Name-Surname (*)

Title (*)

Phone (*)

QUALITY AUTHORIZED PERSON

Name-Surname (*)

Title (*)

Phone (*)

PRODUCTION AUTHORIZED PERSON

Name-Surname (*)

Title (*)

Phone (*)

Bank Name (*)

Account-Iban No (*)

Swift Code (*)

NUMBER OF EMPLOYEES

People (*)

White Collar (*)

Blue Collar (*)

Woman Employee (*)

Man Employee (*)

Disabled Employee (*)

Convicted (*)

OCCUPATIONAL HEALTH AND SAFETY

Are there any risks related to occupational safety in your company? If so, what are the measures taken? (Explain below)

TARD (DANGER ANALYSIS RISK ASSESSMENT)
If this work has been done in your workplace, please attach a copy of the form.

YesNo

ÇBED (ENVIRONMENTAL IMPACT ASSESSMENT)
If this work has been done in your workplace, please attach a copy of the form.

YesNo

AUDIT

If necessary, would you allow us to audit the above documents of our Company's policies and certifications?

YesNo

If your answer is NO / NO, can you explain why?

ISG, Health Safety Environment Commitmnet

(FOR WORKMANSHIP)

The attached commitment form......has been read, understood and signed by us in full.

REFERENCES

Please write company name and contact information

Jurisdiction

COMPANY EXECUTIVE

name-Surname (*)

Title (*)