Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

SUPPLIER/ DISTRIBUTOR NAME:

MANUFACTURER NAME (if different

from above)
PRODUCT TRADENAME:

3M ID Number (xx-xxxx-xxxx-x)

3M RM Number (if known)

3M Region
USA/Canada
EU
Cen/Lat America
APAC
Africa/ME
3M EHS Contact, if different from 3M Contact below:
Phone:
Location:
E- mail:
3M requires suppliers to provide the following information requested on pages 1 to 5 of this form (and
any appendix that has been attached and indicated below) to enable us to determine that the
products you manufacture for 3M comply with global regulatory requirements. Please return this
form to the 3M contact shown below.
Chemical Control Law
Fire Fighting Measures/Stability/Conditions to Avoid
Physical/ Chemical Properties
Additional Hazard Summary Questions
SPIF Appendix (to be filled in by 3M OUS only and returned to MEHS with PFGIF)
Product Packaging
USA & Canada
Brazil
Chemicals of Concern
EU
Japan
REACH SVHC
APAC
Mexico
Metal Content
Prepared by:
Supplier Regulatory or Health/ Safety
Contact
Name:
Position:
Address:

Phone:
Fax:
E-Mail:

3M Contact
Name:
Position:
Address:

Phone:
Fax:
E-Mail:

Supplier certifies that the following information is accurate,

that supplier will update 3M if the information changes, and
that I am authorized to sign on behalf of the supplier.

Signed:
Signed:
Date:
Date:
Please indicate below and attach all relevant documentation to substantiate the information on this
form. Such documentation should include:
Current Material Safety Data Sheet:
(If available)
Supplier Product Specifications
(If available)
Certificate of analysis
(If available)
Results of additional testing (Including methods)
(If available)
Product Technical Data Sheet (storage, handling, disposal)
(If available)
Additional Regulatory information
(If available)
(E.g. country specific classification, transportation classification, agency
certifications (FDA, UL, etc.)
Other
(If available)

Page 1 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Composition Information
1. If the product you are providing to 3M is an article, please provide a
description and a construction diagram of the product as manufactured
for 3M. (If not already provided.)

2. Please complete the table below listing the chemical names and CAS
numbers for 100% of the intentionally added components in your material
either as a range (not exceeding 10% for each component) or typical values.
(In addition, please include known residuals, by-products and/or impurities).
If CAS numbers cannot be provided, please provide generic descriptions of components.
CAS numbers for proprietary components will be protected and used for regulatory
purposes only.
%
Typical

Ingredient
Residual,
By-product,
Impurity

CAS #
--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

--

Select

Click here

Yes

Chemical Name
Min

%
Min

%
Max

Trade
secret
Y/N

NanoParticle?
*

Comment

* Nanoparticles are defined here as intentionally produced solid particles having at least one dimension <100
nanometers (nm). Please answer Yes if more than 1% of the primary particle size distribution by weight or volume
of the chemical meets the nanoparticle definition, and enter in the comment field any known nanoparticle
characterization information, including where available: particle size distribution, median particle size, particle
shape, surface treatment or other surface properties, water solubility, crystalline structure, whether the particles are
free flowing or bound in a matrix, and agglomerate size.

Page 2 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

RoHS, JIG Declarable Substance List or other listed substances

Please complete the chart below. Alternatively, if the supplied item does not
contain any of the RoHS, JIG Annex A Declarable Sunstance List or other
substances listed below, at or above the designated thresholds, you may
certify that by completing the statement found at the end of the table. 3M
expects that all of its RoHS covered supplied materials will conform to the 3M
Corporate EU RoHS Specification, which is available at
http://solutions.3m.com/wps/portal/3M/en_US/SD/Supplier/Requirements/SREE/RoHS/
Designated Substance

1. Asbestos

Threshold1

Contains2
Does Not
(Indicate
Contain
CAS number
and Amount)

Intentionally Added

Check Box Reason Listed3

if contents
report is
based on
test Data
JIG Annex A

Azo colorants and

30 ppm
azodyes which form
certain aromatic amines4
3. 1,2-Benzene1000 ppm
dicarboxylic acid, di-C68-branched alkyl esters,
C7-rich (DIHP)
4. 1,2-Benzene1000 ppm
dicarboxylic acid, di-C711-branched and linear
alkyl esters (DHNUP)
5. Beryllium Oxide (BeO) 1000 ppm

JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

6. 4-[4,4'-bis(dimethylamino) benzhydrylidene] cyclohexa2,5-dien-1-ylidene] dimethylammonium

chloride (C.I. Basic
Violet 3)
7. Boric acid

1000 ppm

JIG Annex A

1000 ppm

JIG Annex A

8. Brominated Flame
Retardants (other than
PBBs, PBDEs or
HBCDD)
9. Cadmium, cadmium
compounds
10. Cadmium, cadmium
compounds
11. Hexavalent chromium,
hexavalent chromium
compounds
12. Cobalt Dichloride

1000 ppm

JIG Annex A

100 ppm or
Intentionally Added
5 ppm by weight of
battery
1000 ppm or
Intentionally Added

RoHS, JIG Annex A

JIG Annex A

RoHS, JIG Annex A

1000 ppm

JIG Annex A

2.

Page 3 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012
Designated Substance

Threshold

3M CONFIDENTIAL
1

Contains
Does Not
(Indicate
Contain
CAS number
and Amount)

Check Box Reason Listed3

if contents
report is
based on
test Data
JIG Annex A

13. Diarsenic Pentoxide

1000 ppm

14. Diarsenic Trioxide

1000 ppm

JIG Annex A

15. Dibutyltin (DBT)

compounds
16. Dioctyltin (DOT)
compounds
17. Dimethyl fumarate

1000 ppm

JIG Annex A

1000 ppm

JIG Annex A

0.1 ppm

JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

RoHS, JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

RoHS, JIG Annex A

JIG Annex A

JIG Annex A

JIG Annex A

1000 ppm
18. Disodium tetraborate,
anhydrous
19. Fluorinated greenhouse Intentionally Added
gases
(PFC, SF6, HFC)
20. Formaldehyde
Intentionally Added
(composite wood
products or
components)
21. Formaldehyde
75 ppm by weight of
textile product
22. Hexabromocyclo1000 ppm
dodecane (HBCDD) and
all major
diastereoisomers
23. Lead, lead compounds 1000 ppm or
Intentionally Added
24. Lead/lead compounds 300 ppm by weight
of childrens product
25. Lead/lead compounds 90 ppm in surface
coatings for
childrens
toys/articles
26. Lead/lead compounds 300 ppm in
cables/cords
coatings
27. Lead/lead compounds 40 ppm by weight of
battery
28. Mercury, mercury
1000 ppm or
compounds
Intentionally Added
29. Mercury/mercury
1 ppm by weight of
compounds
battery
30. Nickel5
Intentionally Added,
where prolonged
skin contact is
expected
31. Ozone Depleting
Intentionally Added

Page 4 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012
Designated Substance

Threshold

3M CONFIDENTIAL
1

Substance (CFCs,
HCFCs, HBFCs, carbon
tetrachloride, etc.)
32. Perchlorates
0.006 ppm

Contains
Does Not
(Indicate
Contain
CAS number
and Amount)

Check Box Reason Listed3

if contents
report is
based on
test Data

JIG Annex A

Intentionally Added
or 1000 ppm
Intentionally Added

JIG Annex A

JIG Annex A

35. Phthalates
1000 ppm
DEHP
DBP
BBP
36. Phthalates
1000 ppm
DINP
DIDP
DNOP
37. Polybrominated
1000 ppm or
biphenyls (PBB)
Intentionally Added
38. Polybrominated diphenyl Intentionally Added
ethers (PBDE)
or 1000 ppm

JIG Annex A

JIG Annex A

RoHS, JIG Annex A

RoHS, JIG Annex A

Intentionally Added

JIG Annex A

50 ppm

JIG Annex A

Intentionally Added

JIG Annex A

1000 ppm

JIG Annex A

43. Radioactive substances Intentionally Added

JIG Annex A

44. Shortchain Chlorinated

Paraffins (C10 C13)
45. Tetraboron disodium
heptaoxide, hydrate
46. Tri-substituted
organostannic

1000 ppm

JIG Annex A

Intentionally added
or 1000 ppm
Intentionally Added
or 1000 ppm

JIG Annex A

JIG Annex A

33. Perfluorooctane
sulfonate (PFOS)
34. Phenol,2-(2Hbenzotriazol-2-yl)-4,6bis(1,1-dimethylethyl)

If your material contains

deca-BDE, indicate here:
Yes
No
39. Polychlorinated
Biphenyls (PCBs) and
specific substitutes
40. Polychlorinated
Terphenyls
(PCTs)
41. Polychlorinated
Naphthalenes
(more than 3
chlorine atoms)
42. Polyvinyl Chloride

Page 5 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012
Designated Substance

Threshold

3M CONFIDENTIAL
1

Contains
Does Not
(Indicate
Contain
CAS number
and Amount)

Check Box Reason Listed3

if contents
report is
based on
test Data

compounds
47. Certain Tributyl Tin
(TBT) and Triphenyl Tin
(TPT) Compounds
48. Tributyl Tin Oxide
(TBTO)
49. Tris (2-chloroethyl)
phosphate (TCEP)

Intentionally Added

JIG Annex A

1000 ppm or
Intentionally Added
1000 ppm

JIG Annex A and 3M PB listed

JIG Annex A

50. Antimony/antimony
compounds
51. Arsenic/arsenic
compounds other than
diarsenic pentoxide and
diarsenic trioxide
52. Beryllium/beryllium
compounds other than
beryllium oxide
53. Bismuth/bismuth
compounds
54. Nickel compounds

1000 ppm

Formerly JIG-B

1000 ppm

Formerly JIG-B

1000 ppm

Formerly JIG-B

1000 ppm

Formerly JIG-B

1000 ppm

Formerly JIG-B

55. Phthalates (other than

DEHP, DBP, BPP, DINP,
DIDP, DNOP - please
list specific chemical
name)
56. Selenium/selenium
compounds
57. Nonylphenol,
octylphenol and their
ethoxylates
58. Latex Rubber

1000 ppm

Formerly JIG-B

1000 ppm

Formerly JIG-B

Intentionally Added

Norway Regulation, EU
Directive

Intentionally Added

59. 4,4'-methylenebis(2,6diethylaniline) (CAS

13680-35-8)
60. Tribromo bisphenol A
(phenol, 2,2',6-tribromo4,4'-isopropylidenedi)
(CAS 6386-73-8)
61. Hexachlorobenzene
(CAS 118-74-1)
62. (Poly) brominated
Intentionally Added
substances

3M PB listed substance

3M PB listed substance

3M PB listed substance

3M Europe

Page 6 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

If a material/substance is intentionally added, then it needs to be reported regardless of its content level. If a
material/substance is otherwise present, then its threshold level applies.
2

Contain or Does Not Contain means that the material is or is not present at or above the threshold noted above. If
the material contains the substance, please provide the amount, and the Chemical Abstracts Service (CAS) Number of the
substance. For RoHS-restricted substances, the concentration levels should be determined by weight in any
homogeneous material as defined in the RoHS Directive 2011/65/EU (recast) which can be found at http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:174:0088:0110:EN:PDF . For non-RoHSrestricted substances, when a law exists that sets a threshold for a material or chemical, the concentration levels (ppm)
should be determined based on the methodology set forth in that law. When a law does not exist, concentration levels
(ppm) should be determined based on the total weight of the product or subpart for which the declaration is being
developed.
3

JIG Annex A means the JIG-101 Ed 4.0, March 10, 2011, Joint Industry Guide Material Composition Declaration for
Electrotechnical Products, Annex A (Normative) JIG Declarable Substance List. Suppliers should also refer to the Annex
B (Informative) Detailed Substance Lists with CAS Numbers and/or EC Numbers, which contains non-comprehensive
listings of CAS numbers and/or EC numbers if applicable or available for the substances or categories listed in Annex A.
Formerly JIG-B means the September 18, 2007 Joint Industry Guide, JIG-101 A, List B, and 3M PB Listed
Substance means that the substance is contained on 3Ms list of Persistent and Bioaccumulative Substances.
4

The European Community's ban applies to azocolorants and azodyes that by reductive cleavage of azo groups may
release one of the aromatic amines listed in JIG 101 Ed 4.0 Annex B. The threshold level given applies to these amines,
not to the azocolorants and azodyes.
5

Nickel alloys are not reportable. Nickel must be reported in certain regulated applications where it is likely to result in
prolonged skin exposure (e.g., an outer enclosure for a portable electronic product designed to be carried). Use of nickel
or nickel in components and parts designed to be located inside the outer enclosure of a product need not be reported.

Material Certification
Supplier certifies that the supplied item does not contain any of the RoHS
substances listed above, at or above the thresholds designated, unless the
substance is in an application that is exempt under RoHS. If relying on an
exempt application under RoHS, specify here:
Our products currently contain RoHS substances, at or above the
thresholds designated. Supplier certifies that we will phase out the
substances below, after which we will resubmit this information.
Substance:
Expected phase-out date:
Supplier certifies that the supplied item does not contain any of the
other substances (not including RoHS substances) listed on the preceding
pages (JIG Annex A or other listed substances), at or above the thresholds
designated.

ISO Certification
1. Are you ISO 14001 Certified?
Page 7 of 18

Yes

No

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Please provide a copy of the certificate if available.

2. Are you ISO 9001:2008 registered?
Yes
Please provide a copy of the certificate if available.

Page 8 of 18

No

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Chemical Control Laws Appendix

Is the finished product (all components) listed on the country specific chemical
inventories in the table below? Check all boxes that apply.
If your material contains chemical component(s), including impurities, which are regulated
or banned in a listed country provide an explanation in the table below.
If your material is exempt because it is an article, please specify below.
Inventory
Australia1
(AICS)
Canada2
(DSL)
Canada2
(NDSL)
China3
(IECSC)
Europe4
(EINECS)
Europe4
(New Notified Substance)
(ELINCS)
Europe (No Longer
Polymer
Japan5
(METI/CSCL)
Japan6
(MHLW/ISHL)
Korea
(KECI)
Philippines
(PICCS)
USA
(TSCA)

YES

NO

Notification
in progress

Exempt Comments (e.g. CAS # of

banned chemical, exempt for
article. Polymer etc)

Not applicable

Not applicable

AICS online
http://www.nicnas.gov.au/obligations/aics/search.asp
http://www.nicnas.gov.au/
3
IECSC Inventory of Existing Chemical Substance in
China
http://www.crc-sepa.org.cn/
5
National Institute of Technology and Evaluation
(METI/CSCL inventory)
http://www.safe.nite.go.jp/english/db.html

Location of material production (Country)

Canada DSL/NDSL
http://www.ec.gc.ca/substances/nsb/eng/cas_e.htm
European Chemical Bureau (European Chemical
Substances Information System ESIS)
http://ecb.jrc.it/
6
MHLW/ISHL inventory (Japanese only)
http://www.jaish.gr.jp/anzen/html/select/ankg00.ht
m
4

Page 9 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Physical/ Chemical Properties Appendix

Please add the following required physical properties if they do NOT appear
on the MSDS
(For materials defined as articles, only Physical State is required)
Physical State
Solid/Liquid/Gas:Select Odor
Color
For solid, please specify physical form (e.g. roll, sheet, block etc)
Specific gravity/ Density:
Not applicable: Select
Min:
Max:
Conditions:

Typical:

Units:
Comment:

Flash Point:
Not applicable: Select ( Specify when there is no flashpoint)
Min:
Max:
Typical:
Units:
Conditions:
Comment:
Suggested others include:
Property

Min

Max

Typical

UNITS

Comments

pH
Boiling/meltin
g point
Viscosity
Solubility in
water
% Volatile
Vapour
density
Grade
Evaporation
rate
Kow Oct/Water
partition
coefficient
Viscosity

Page 10 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Fire Fighting Measures/Stability/Conditions to Avoid Appendix

Please provide the following information if is does NOT appear on the MSDS.
Fire Extinguishing Media

Special Fire Fighting Procedures/Unusual Fire and Explosion Hazards

Stability
Stable
Unstable (describe):

If product is unstable,
describe:

Hazardous Polymerization
Will not occur
May occur (describe):

If polymerization may
occur, describe:

Materials / Conditions to Avoid (check all that apply select at least one)
None known
Heat is generated during cure. Do not cure a
mass larger than 50 grams in a confined space
Accelerators
to prevent a premature reaction (exothem) with
Al or Mg powder and high/shear temperature
production of intense heat and smoke
conditions
High shear and high temperature conditions
Alcohols
May form explosive peroxides. Do not use
Alkali and alkaline earth metals
beyond expiration date
Aluminum
Metal powder
Amines
Reaction with water, alcohols, and amines is
Avoid curing large quantities of material to
not hazardous if container can vent to the
prevent a premature reaction (exotherm) with
atmosphere to prevent pressure buildup
production of intense heat and smoke
Reactions with metals in powder form occur
Avoid shock or friction
from 370 degrees C onwards
Combustibles
Reactive metals
Drugs, medicines and/or food supplies
Reducing agents
Explosive when dry
Sparks and/or flames
Explosive when mixed with oxidizing
Strong acids
substances
Strong bases
Finely divided active metals
Strong oxidizing agents
Forms explosive metallic compounds. Avoid
Temperatures above the boiling point
contact with metals and metal salts
Water
Heat
Zinc
Other (describe):
Protect from freezing?

Protect from heat?

Fill in either Specific Use or Intended Use or both

Specific Use
Market Type
Select one...
Optional...

Dry ice?

Maintain at Select
one...

Intended Use

Page 11 of 18

Optional...

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Additional Hazard Summary Questions Appendix

Hazard Summary Questions (additional information)
Can this material bond tissue?

Yes

No

Not Applicable

Can this material cause frostbite?

Yes

No

Not Applicable

Can this material cause thermal burns?

Yes

No

Not Applicable

Does the anticipated use of this material include curing?

Yes

No

Not Applicable

Does the anticipated use of this material include cutting, grinding, sanding, or machining?

Yes

No

Not Applicable

Yes

No

Not Applicable

Does the anticipated use of this material include heating?

If yes, to what temperature?

Select one...

Does the anticipated use of this material include spraying?

Yes

No

Not Applicable

Does the material sublime?

Yes

No

Not Applicable

Does thermal degradation of this material produce fumes (very small particulates not vapor
or odor)?

Yes

No

Not Applicable

Does this material degrade in light?

Yes

No

Not Applicable

Does this material generate vapor or dust during transfer tasks or at transfer points?

Yes

No

Not Applicable

Does this material produce a dust during normal use?

Yes

No

Not Applicable

Does this material produce a dust, mist, vapor, fume or spray during normal use?

Yes

No

Not Applicable

Does this material produce a vapor during normal use?

Yes

No

Not Applicable

Does this material react violently with water or air?

Yes

No

Not Applicable

Does this molten material generate air contaminants upon handling or extrusion?

Yes

No

Not Applicable

Is the material cured during normal use with resultant airborne contaminants?

Yes

No

Not Applicable

Is the material fluorinated?

Yes

No

Not Applicable

Is the material heated above its boiling point?

Yes

No

Not Applicable

Is this a material with a long half-life in the body?

Yes

No

Not Applicable

Page 12 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

SPIF Appendix (3M Internal use only)

To be completed by 3M personnel only and returned to CT&RS with the PFGIF

Contact Information
Requestor Name :
(person to contact for more
information)
Telephone # :

Completed by Corporate Toxicology & Regulatory

Services (CT&RS)

Material Short Name (20 characters) :

Date Originated :

Date Required :

Type of Request :

New Formulation

Document Group / MSDS # :

Reformulation
Will product be exported?
If Yes, list export countries :

Select one...

Material Information
Trade Name / Product Name

Type
Select one...

This product is:

a new product
the same as an existing product
similar to an existing product

Division
Select one... or Select one...
one...

or

Select

Country

If the same as or similar to an existing product, enter the following

information for the existing product:
Trade Name / Product Name
Document Group /
MSDS #

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Stock / Internal #

Package Size / Type / Style

Comments
Requestor Comments:
PRL Comments:

Page 13 of 18

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

Brazil Appendix
Please complete the table below. Alternatively, if your materil does not contain
any of the substances listed below, at or above the designated thresholds, you
may certify that by completing the statement found at the end of the table.
Threshold1

Contains2
(Indicate
CAS
number)

Amount

1. Cadmium and Compounds

5 ppm

2. Lead and Lead Compounds

30 ppm

3. Mercury & Mercury

2 ppm
Compounds
4. Hexavalent Chromium and
5 ppm
Chromium Compounds
5. Polybrominated Biphenyls
0 ppm
(PBB)
6. Polybrominated Diphenylethers 0 ppm
(PBDE) (including
decabromodiphenyl ether DecaBDE)
7. Asbestos
0 ppm

8. Other brominated organic

compounds
9. Ozone Depleting Substance
(CFCs, HCFCs, HBFCs,
carbon tetrachloride, etc.)
10. Polychlorinated Biphenyls
(PCB)
11. Polychlorinated Naphthalenes
(PCN) (more than 3 chlorine
atoms)
12. Polychlorinated Terphenyls
(PCT)
13. Radioactive Substances

1000 ppm

0 ppm

0 ppm

0 ppm

0 ppm

1000 ppm

14. Shortchain Chlorinated

Paraffins
15. Other Chlorinated organic
compounds
16. Tributyl Tin Compounds

0 ppm

1 ppm

0 ppm

17. Triphenyl Tin Compounds

0 ppm

18. Azo colourants (Azo Dyes)

0 ppm

Designated Substance

Page 14 of 18

Does Not
Contain

Check Box if
contents
report is
based on test
Data

 Global Purchased Finished Goods Information Form (PFGIF)

Version 2.07 May 2012

3M CONFIDENTIAL

19. Formaldehyde

0 ppm

20. Antimony/Antimony
Compounds
21. Arsenic/Arsenic Compounds

1000 ppm

0 ppm

22. Beryllium/Beryllium
1000 ppm
Compounds
23. Bismuth/Bismuth Compounds 1000 ppm

24. Nickel/Nickel Compounds3

25. Selenium/Selenium
1000 ppm
Compounds
26. Specific phthalates (DEHP,
1000 ppm
DBP, BBP, DINP, DIDP, DNOP,
DNHP)
27. Hydrofluorcarbon (HFC)
0 ppm

28. Perfluorocarbon (PFC)

0 ppm

29. Methyl Bromide

1 ppm

30. Ugilec 141 (tetrachlorodiphenyl

methane)
31. Ugilec 121 (monomethyl
dichlorodiphenyl methane )
32. Monomethyl-dibromodiphenyl methane (DBBT)
(CAS 9688-47-8)
33. Siloxane

10 ppm

10 ppm

Intentionally
Added

0 ppm

34. Perfluoro-octane-sulfonic acid 0 ppm

and its salts
35. Specified benzotriazole
0 ppm

36. Dichloromethane
(CAS 75-09-2)
37. Trichloroethylene (CAS 7901-6)
38. Perchloroethylene (00127-184)
39. Monomethyl-tetrachlorodiphenyl methane
(CAS 76253-60-6)
40. Monomethyl-dichloro-diphenyl
methane

Intentionally
Added
Intentionally
Added
Intentionally
Added
Intentionally
Added

Intentionally
Added
Intentionally
Added

41. Monomethyl-dibromodiphenyl methane (DBBT)

(CAS 9688-47-8)

0 ppm

If a material/substance is intentionally added, then it needs to be reported regardless of its content level. If a
material/substance is otherwise present, then its threshold level applies.

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Contain or Does Not Contain means that the material is or is not present at or above the threshold noted above. If
the material contains the substance, please provide the amount, and the Chemical Abstracts Service (CAS) Number of the
substance. When a law exists that sets a threshold for a material or chemical, the concentration levels (ppm) should be
determined based on the methodology set forth in that law. When a law does not exist, concentration levels (ppm) should
be determined based on the total weight of the product or subpart for which the declaration is being developed.
3
Nickel alloys are not reportable. Nickel and Nickel compounds must be reported when used in applications where
nickel compounds are likely to result in prolonged skin exposure (e.g., an outer enclosure for a portable electronic product
designed to be carried). Use of nickel or nickel compounds in components and parts designed to be located inside the
outer enclosure of a product need not be reported.

Material Certification
Supplier certifies that the supplied item does not contain any of the
substances listed in the table above at or above the thresholds designated.

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REACH SVHC Appendix: Substances of Very High Concern (SVHC)

Substances of very high concern are defined in Article 57 of Regulation (EC) No 1907/2006 (The
REACH Regulation) and include substances which are:
1. Carcinogenic, Mutagenic or Toxic to Reproduction (CMR), meeting the criteria for
classification in category 1 or 2 in accordance with Directive 67/548/EEC,
2. Persistent, Bioaccumulative and Toxic (PBT) or very Persistent and very Bioaccumulative
(vPvB) according to the criteria in Annex XIII of the REACH Regulation, and/or
3. Identified, on a case-by-case basis, from scientific evidence as causing probable serious
effects to human health or the environment of an equivalent level of concern as those
above (e.g. endocrine disrupters)
If your material contains any substance(s) that meet the criteria of Article 57 please
complete the table below:
Substance Name

CAS Number

EC Number

Amount Max Check Box if

Reason
% (w/w)
Contents
Report is basede.g. CMR
on Test Data

The Candidate List of SVHC according to REACH Art.59(1) is updated regularly by the
European Chemicals Agency (ECHA) and published on their website:
http://echa.europa.eu/web/guest/candidate-list-table
Substances proposed to be placed on the Candidate List are published on the
consultation website:
http://echa.europa.eu/web/guest/proposals-to-identify-substances-of-very-high-concern
3M will have to request updated SVHC certification information from you each time
these lists are updated. You can avoid these multiple requests for additional
composition information by supplying 3M with 100 % composition (see page 2 of the
Raw Material Information Form).
As a minimum, please provide 3M with composition information regarding the current
version of the candidate list and substances proposed to be placed on the candidate
list.
Please complete the table above or alternatively, if your material does not contain any of the
substances listed, you may certify that by completing the statements below
Note: For salts, the information requested and the certification applies to the substances and the possible hydrates of the
substances even if not listed separately.

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Material Certification
Supplier certifies that 100% composition has been provided on page 2 of this document.
Supplier certifies that the supplied item does not contain any of the substances listed in
the Candidate List or which are proposed to be placed on the Candidate List and published
for consultation.
Status date
Supplier certifies that the supplied item does not contain any of the substances listed in
the declarable substance list of TR 9535-9536.
Status date
Please consult the declarable substance list of TR 9535-9536 (Technical Standard for Aerospace) which can
be found at http://www.asd-stan.com/ (follow the link chemical substance declaration form).

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