(Insert Company Letterhead)
*** By signing this document you are representing that you are authorized to make
claims on behalf of your company in regards to REACh, Prop 65 and/or RoHS 2/3, and
that such claims can be relied upon ***
Company Name:
DECLARATION OF RoHS COMPLIANCE
RoHS 2 Compliance Statement
The part(s)/product(s) in this declaration do not contain any of the below substances above the maximum
concentration values identified in Annex II of the RoHS Directive (2011/65/EU), unless using an exemption as
Compliant
those listed RoHS Parts
in Annex List
III and See
IV, which can Attached
be viewed here:
http://assentcompliance.com/AssentU/Downloads/Assent-SupplierSuccessCentre-RoHSExemptionList.pdf.
Substance Exemption
Part Number(s) Present Number Weight (g)
Quantity limit: 0.1 % of weight (1000ppm) of Description
any homogeneous material: (If (If (If Applicable)
Supplier Tridien Applicable) Applicable)
1. Lead (Pb)
2. Mercury (Hg)
3. Hexavalent Chromium (Cr VI)
4. Polybrominated Biphenyls (PBB)
5. Polybrominated Diphenyl Ethers (PBDE)
Quantity limit: 0.01 % of weight (100 ppm) of any 'homogeneous material:
1. Cadmium (Cd)
Non-Compliant RoHS Parts List N/A See Attached
Supplier Tridien
If the amount of a substance exceeds the allowable limit and a RoHS exemption is applicable, the appropriate
exemption must be listed in the RoHS Compliant Parts List below.
Compliant RoHS Parts List
Substance Exemption
Present Number Weight (g)
Part Number(s) Description (If (If (If Applicable)
Applicable) Applicable)
If the amount of substance exceeds the allowable limit and a RoHS Exemption is not applicable, the part must
be listed in the Non-Compliant RoHS Parts List below.
Non-Compliant RoHS Parts List N/A
Substance Weight (g)
Part Number(s) Description Substance Name CAS No. (If Applicable)
*** By signing this document you are representing that you are authorized to make
claims on behalf of your company in regards to REACh and/or RoHS 2/3, and that such
claims can be relied upon ***
RoHS 3 Compliance Statement
The part(s)/product(s) in this declaration do not contain any of the below substances above the maximum
concentration values identified with amendment RoHS Directive (2015/863/EU).
Compliant RoHS Parts List See Attached
Quantity limit: 0.1 % of weight (1000ppm) of any homogeneous material:
Substance Exemption
Part Number(s) Present Number Weight (g)
Description
1. Bis(2-Ethylhexyl) phthalate (DEHP) (If (If (If Applicable)
Supplier Tridien Applicable) Applicable)
2. Benzyl butyl phthalate (BBP)
3. Dibutyl phthalate (DBP)
4. Diisobutyl phthalate (DIBP)
Non-Compliant RoHS Parts List N/A See Attached
Supplier Tridien
Compliant RoHS Parts List
Substance Exemption
Present Number Weight (g)
Part Number(s) Description (If (If (If Applicable)
Applicable) Applicable)
If the amount of substance exceeds the allowable limit and a RoHS Exemption is not applicable, the part must
be listed in the Non-Compliant RoHS Parts List below.
Non-Compliant RoHS Parts List N/A
Substance Weight (g)
Part Number(s) Description Substance Name CAS No. (If Applicable)
Print
Name: Signed:
Title: Date:
