AFRDI 150 Sustainability Standard – Commercial furniture Assessment Application Form

  • Each applicant submitting product for assessment must complete page 1 of this form.
  • Page 2 and 3 of this form must be completed for each product[a] you are submitting for assessment.
  • The completed form must be returned to AFRDI via email (or fax (03) 6326 3090) before an assessment can begin.
  • Please refer to the AFRDI Green Tick Information Kit for further information or call AFRDI on 03 6326 6155.

Applicant Information

*Name of applicant[b]: (1 name only)...... Type here......

*Name of primary contact[c]:...... Type here......

*(Street) address of applicant...... Type here......

*Telephone number...... Type here......

Fax number...... Type here......

[*]Email address...... Type here......

Website URL...... Type here......

ABN number...... Type here......

Authorisations and Declaration

I warrant and declare that the applicant information provided above is accurate in every detail.

*Signature of authorised officer:……………………………

*Name: (PRINT)...... Type here......

*Position in company:...... Type here......

*Date: Click here to enter a date.

Product Information

*Product designation:[d] (1 name only)...... Type here......

*Product Type:[e]...... Type here......

*Applicant’s relationship to product:[f]...... Type here......

*Company who assembles/

manufactures the product:...... Type here......

*Address where product is assembled/

Manufactured:...... Type here......

Scope/details of the operational...... Type here......

activities of the site where the ......

product is assembled/manufactured:......

*Desired AFRDI 150 level:Click here to select desired AFRDI 150 level

*Quote required:(Yes/No)[g]...... Type here......

When requesting a quote,further information such as images of the product and/or brochures should beprovided to AFRDI. AFRDI will contact you regarding quoting.

Attached documents:...... Type here......

*Additional briefing session(s): [h]Click here to select desired No. of briefing sessions

[*]If an AFRDI Green Tick Certificate is to be issued for the product(s) described aboveFurntech-AFRDI WILL publicise this on its website. You may however opt NOT to have a PDFof the certificate uploaded by changing the following selection:

I want AFRDI to publish the certificate on its website.

Authorisationsand Declaration

I warrant and declare that the product information provided in this formand attached documents is accurate in every detail and I authorise Furntech-AFRDI or its agents to carry out the assessment(s) to AFRDI 150Sustainability Standard – Commercial Furniture at the level specified above.

*Signature of authorised officer:……………………………

*Name: (PRINT)...... Type here......

*Position in company:...... Type here......

*Date:Click here to enter a date.

Application Form - AFRDI Green Tick - December 2015.docxPage 1 of 3

AFRDI 150 Sustainability Standard – Commercial furniture Assessment Application Form

Product’sComponent/Material and Packaging Material List

*Product designation...... Type here......

*Total product weight (to nearest 0.01kg)...... Type here......

* Component or MaterialDesignation / * Component or Material Type / * Place of Manufacture / * Manufacturers Name / * Weight (to nearest 0.01kg) / Comments (optional)
(example only) Work Station Top, WS1234 / MDF Board, Wood / Sydney, Australia / The Laminex Group / 8.35 Kg / FSC Certified and E1 Grade

Notes:

*It is mandatory that information marked with an asterisk be supplied.

Application Form - AFRDI Green Tick - December 2015.docxPage 1 of 3

Notes:

[a]If a large number of product is to be submitted for assessment then product and assembly/manufacturing site information can be listed in a spread sheet attached to this form, provided it is referenced on this form in the space provided.

[b]The applicant is the organisation who is submitting the product for assessment.

[c]The person Furntech-AFRDI should contact regarding matters pertaining to the assessment.

[*]It is mandatory that information marked with an asterisk be supplied.

[d]The name of the product as you wish it to appear on the AFRDI Green Tick certificate. The name can be amended prior to a certificate being issued at no additional fee.

[e]Product type examples are: desks, fixed height chairs, height adjustable swivel chairs (office chairs), storage furniture.

[f]Whether the applicant is for example: the full product manufacturer, product assembler from supplied components, product distributor of a pre-assembled product or an intermediary representative for a product manufacturer.

[g]Select No if a recent quote for the assessment of the product has already been provided. Payment is required prior to an assessment beginning.

[h]One briefing session is available to new Australian based applicants. Additional briefing sessions are available to Australian based applicants for an additional cost.

[*]It is mandatory that information marked with an asterisk be supplied.