/ Self-declaration form
Textile materials / Spec. nr:
Date:
Version nr / IOS-MAT-0010
2013-05-10
AA-10911-11

Self declaration for textile materials, according to IOS-MAT-0010

This form shall be used to certify compliance with requirements according to specification IOS-MAT-0010 (AA-10911-11). This form – or an equivalent form with the same information -is to be signed by the final chemical processor(final material producer) in the supply chain of the textile, meaning the last manufacturer who adds any chemical preparation to the textile, e.g. finishing, or who washes it. This can be either the IKEA supplier or a sub-supplier( or a sub- sbu-supplier, etc.).

The self declaration shall be in English – addition of information in local language is voluntary.

Supporting documents,verifying fulfillment of the requirements, shall be listed in Table 3, such as:

  • Test reports,
  • Self declarations or certificates from each sub-supplier of raw materials and chemicals used to make the textile material.

Table 1. List of textile materials
Material identification(trade name, article code, quality and/or other identification)[1] / Material composition (type o material such as material base con-tent, physical charac-teristics, colour etc.) / Material identification(trade name, article code, quality and/or other identification)1 / Material composition (type o material such as material base content, physical characteristics, colour etc.)
Velours Light Blue plain GB BA40
P34-4001-4-50399-230 / 34%cotton-32%polyester-22%modeacrylic-12%viscose / Berdalen GB White
GA705-8774-1-5119-230 / 33%polyester filling-31%polyester-12,5%viscose 23,5%modeacrylic
Bakkeby GB Light Blue BA40
A702-4001-4-50399-230 / 34,5%cotton-31%polyester-22,5%modeacrylic-12%viscose / Briksdale No Zones 230
G711-11658-1-51899-230 / 100%cotton
Bakkeby GB White
A702-4001-1-50399-230 / 34,5%cotton-31%polyester-22,5%modeacrylic-12%viscose / Dölemo White EU 237
G713-12200-1-5099-237-270 / 36%cotton-64%polyester
Bauker EU White
G707-8772-1-50399-237 / 24%cotton-34%polyester-42%cotton filling / Dölemo GB White
G714-1220-1-51199-237 / 100%polyester
Bauker GB White
G708-8772-1-51199-237 / 21%modeacrylic-11%viscose-34%polyester-34%polyester filling
Table 2. Confirmation of fulfilment of chemical requirements
Requirements
See IOS-MAT-0010 for specific information on each requirement / Type of textilematerial / Fulfils / Not applicable
Authorisation substances according to EU REACH Annex XIV[2] / All
Cadmium and its compounds / All
CMR substances 1A or 1B2 / All
Hazardous waste / Material that contains any proportion of recycled material
Lead and its compounds / All
Other SVHC2 / All
PBT-substances and vPvB-substances2 / All
Alkylphenolethoxylates (APEO), AP, AP phosphites and other AP derivatives / All
Antimoth agents (wool materials) / Wool
Azodyes that may release carcerogenic arylamines
Bisphenol A / Material where colouring agents have been added
Material with any content of recycled synthetic fiber
Chlorinated aromatic dye carriers/leveling agents / Polyester and polyester-containing blends
Chlorine and chlorine compounds for bleaching or delignification / Any material containing natural or regenerated fibers
Dimethylformamide / Polyurethane-containing textiles including coatings
Dyestuffs classified as carcinogenic or allergenic / Dyed, printed or otherwise coloured materials
Formaldehyde
Heavy metals (extractable)
Haxavalent chromium (Cr-VI) compounds / All
All
Synthetic fiber and wool
Lindane
Mercury (Hg) and its compounds / All
Synthetic fiber
Organic solvents in printing paste / Printed textile
Organotin compounds / All
PCP, TeCP, TriCP / All
Phthalates
Polycyclic aromatic hydrocarbons (PAH) / All
All
PVC / All
Primary aromatic amines (PAA) / All
Fulfils
(no use) / Used (IKEA approval required)[3]
Biocides of all kinds, added in order to impart properties to the final product / All
Fragrances / All
Flame retardants / All / [4]
Recycled material from external source / All
Fulfils
(No use) / Fulfils migration limit[5] / Not applicable
Optical brightening agents / Skin-contact materials and materials with ban acc. to ref. in TED
Fulfils
(no use) / Used (IKEA approval required) / Not applicable
Perfluorinated compounds / Materials treated for oil, water and/or stain repellancy / [6]

Note: “Not applicable” shall only be ticked if the material being declared is not in the scope of the requirement according to IOS-MAT-0010.

Table 3. Additional required information on Flame retardant used
Trade name of flame retardant / Manufacturer
NA / NA
Table 4. List of supporting documents
Document / Source (issuer of document)
Asumin 527 / MSDS
Azijnzuur 80% / MSDS
Natrium Hydroxide / MSDS
Persoftal Hydrosoft / MSDS
Persoftal L / MSDS
Proder JT LF25 / MSDS
Tanacid NAC / MSDS
Tannex Noveco / MSDS
Waterstof peroxide / MSDS
Comments (optional)
These test has been done by the following test institutes:
-Intertek, Hong Kong, China
-Intertek UK
-Intertek Turkey
- TUV Germany

This is to certify that we have read and understood IKEA specification IOS-MAT-0010 and that the the materials listed in Table 1complywith IKEA requirements according to specification IOS-MAT-0010 (AA-10911-11).

Even if this form is signed by a sub-supplier(or sub-sub-supplier, etc.) to the IKEA supplierIOS-MAT-0010 as part of the Purchasing Agreement between IKEA and IKEA supplier always applies, and compliance is the final responsibility of the IKEA supplier in all cases.

Name of IKEA supplier or
sub-supplier / Innofa BV Europe
If IKEA supplier: Supplier no: / 21479
If sub-supplier:
Address and phone no:
Place and date: / Tilburg, 15 January 2014
Name and signature: / Paul Roborgh

© IKEA of Sweden AB • 2013Page 1(1)

[1]If the final textile material in itself is the complite IKEA article, then IKEA article names and numbers can be given.

[2]When referring to chemical substances that are included in lists established by government authorities, this SD applies to chemical substances that are included in such lists at the time of signing.

[3]Documentation as required in the approval from IKEA shall be attached to this SD.

[4]“Fulfils (no use)” = No use of any flame retardant or only use of melamine, chalk, graphite, kaolin or modacrylic fibre.

[5]For skin-contact materials (if use allowed).

[6]Use of other perfluorinated or partially perfluorinated organic compounds may be given IKEA approval (but not PFOA/PFOS/PFOSA).