BOOKING FORM – Corporate Social Responsibility Services

SLCP Verification Services

To (BV CPS Office): Attention: Date:

FOR EACH VERIFICATION THE BELOW SECTIONS MUST BE COMPLETED CLEARLY, ACCURATELY AND IN FULL.
SLCP Member Name if applicable:
Type of Services Requested: FSLM
SLCP Verification: Announced Y Semi-Announced with 10 working days window
1. The overall completion percentage is more than 95% in the self-assessment Y /N
SLCP Self-Assessment 2. Which steps have you reached in the self-assessment? Step 1
YCompleteness Step 1 + 2 Y
Step 1 +2 +3
Final Verification Report Distribution: Client / Retailer Requesting Company Vendor Company Factory Y
Desired verification date or due period: Previous BV Report No. for reference:
Verification payee: Client / Buyer Requesting Company Y Vendor Company Factory (Verification site)

Additional notes:

Requesting Company Name: PT Dong Jung Indonesia

Address: Jl.Sumatra Raya Blok. E 04 Cilincing
City: DKI Jakarta Utara Province or state: DKI Country: Indonesia Postal Code: 14140
Contact Person(s): Ozin Tel: 0214403926 Fax: 0214403944 E-mail: ozindji35@gmail.com
Additional notes:

Vendor Company Name (if different than requesting company):

Address:
City: Province or state: Country: Postal Code:
Contact Person(s): Tel: Fax: E-mail:
Additional notes:

Factory Name (in SLCP Gateway& Accredited Host platform):

Factory Name (Verification Site) in local language:
Facility ID (Factory’s Facility ID in SLCP Gateway Platform)
Address:
City: Province or state: Country: Postal Code:
Contact person(s): Tel: Fax: E-mail:
Address in local language:
Directions to factory if needed:
Production Process: Product(s) produced:

Total No. of Staff(Total Staff No included Management Staff& Production Workers）: 21

No. of Workers (refer to production workers only, excluded the non-production workers) :131
Note (Definition of Worker): In SLCP, worker equals to production worker (production employee). Persons working on/with the
facility's product, ensuring machinery is working to produce product, or directly involved in the operations of the facility.They are non-
supervisory, which means no one report to them (if a person is in a supervisory role, e.g. sewing line group leader, they would not be
counted as “worker”).Facilities include those involved in production of goods, and also those involved in operations related to the
product, e.g. distribution. Examples of "workers" are cutters, sewers, QC, packers, etc. (all workers who contribute to producing the
product), boiler workers, mechanics (machine repair persons), electricians and workers who load product onto trucks.

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 Primary Language Spoken by Production Workers (the language most production worker can speak& understand）: _________
Secondary Languages Spoken by Production Workers（excluded main language, the language most production workers can
speak& understand）: ____________
Including % of Production Workers Spoken These Languages (Please list all Languages including National Language, English,
Foreign Languages and Local Dialect, etc.):
Primary Language:_Indonesia__________ Corresponding % _100___________
Secondary Language:________ Corresponding % ______________
Other Language:____________ Corresponding %_______________
Other Language:____________ Corresponding %_______________
Other Language:____________ Corresponding %_______________
If more languages than above used by production workers please list the language with corresponding % here ：
__________________________________________________________________________________
Note: For example, for a factory in China with production workers from China and also from Vietnam and Indonesia, among
production workers, if all production workers including foreign workers can speak& understand Chinese, and 40% can speak&
understand Vietnamese, 20% can speak& understand Indonesian Language, then the information to be filled above shall be:
Primary Language- Chinese-with percentage 100%, Secondary Language-Vietnamese-with percentage 40%, Other Language-
Indonesian Language-20%.
For example, for a factory in China with production workers from China and also from Vietnam and Indonesia, among production
workers, if all production workers including foreign workers can speak& understand Chinese, and 60% can speak& understand
English, 35% can speak& understand Vietnamese, 25% can speak& understand Indonesian Language, then the information to be
filled above shall be: Primary Language- Chinese-with percentage 100%, Secondary Language-English-with percentage 60%, Other
Language- Vietnamese Language-35%.Other Language- Indonesian Language-25%.
Please note to list name and percentage of Local Dialects if any used by production workers, for example in China factory some workers
may use Mongolic languages, Tibetan(Zang Language), Uyghur Language, Yue-Yue Chinese, Min Nan Yu, etc.
Primary Language Spoken by Management & Supervisors:
Additional notes:

PLEASE SEE PAGE 3 FOR TERMS AND CONDITIONS

We apply for the above services and agree that all services will be carried out subject to the Bureau Veritas Consumer Products
Services quotation and/or proposal received by our company as amended by the special terms and conditions stated on page 2 of this
form.
Date: 17 Jan 2024 Authorizing name: ozin Signature and company chop:

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 BUREAU VERITAS CONSUMER PRODUCTS SERVICES – Corporate Social Responsibility Services
TERMS & CONDITIONS
Terms Definition / Condition Unit Price
The ability of BV CPS verifier to conduct a credible verification depends on factory management’s
cooperation and willingness to provide verification access to employees for confidential interviewing,
Verification Site Access n/a
documentation for review (including payroll and attendance records), and access to all areas of the
factory for visual observation.

Booking Lead Time Request for verification should be made 30 calendar days prior to the desired verification date(s). n/a

Verification findings are based on crosschecking data gathered from visual observation, confidential
Scope n/a
worker interviews, management interviews, and documentation review.
To effectively execute the verification confidential worker interviews are undertaken. It is BV's position to
ensure that workers of factories will not be retaliated against due to comments or information obtained
during the verification process. In absence of objective evidence and to ensure the integrity of the
verification process, BV reserves the right to non disclosure of information obtained from workers to the
factory. Therefore, information obtained from interviews will be kept confidential and may not be included
Distribution of Worker in the final verification report.
Interview Information By accepting these terms and conditions you authorise BV to communicate where applicable worker
interview information that may not be contained in the final report to the payee of the verification and/or
the master client/retailer who owns the COC programme.
If the factory is the payee of the verification and the verification is NOT part of a master client/retailer
programme then the worker interview information will NOT be communicated to any parties without the
expressed permission of the factory.
Man-day 8 hours spent on working and/or traveling with 1 hour break and in compliance with local labor law. As per agreement with client
Normal Working Days Mon – Fri (or in compliance with local labor law and customs) n/a
Working on 20% surcharge (of total Man-day fees)
If express service or other request requires that BV verifiers work on weekends.
Weekends
Working on Holidays If express service or other request requires that BV verifiers work on Public Holidays. 30% surcharge (of total Man-day fees)
Express Service Rush / ASAP booking within 7 days from desired verification date. 50% surcharge (of total Man-day fees)
Access Denied Scheduled verification or assessment was not performed due to factory management not allowing BV Invoiced in full including Man-day
Charge staff to enter or conduct the verification or assessment for reason outside the control of BV staff. fee(s) and all expenses incurred
Late Cancellation Cancellation of the verification less than 48 hours from scheduled verification day if verifiers cannot be Invoiced in full including Man-day
Charge re-assigned to alternate verification. fee(s) and all expenses incurred
Up to 4 hours: additional 0.5 Man-day
Extra Traveling Time 1. If travel is required on the day before or the day after the verification
More than 4 hours: additional 1.0
Charge 2. Waiting time day before or day after the verification date due to the lack of transport resources.
Man-day
Flight Charge Cost of air travel for standard coach Invoiced at cost
Invoiced at cost or in accordance with
Traveling Expense Cost of travel expense other than air
pre-approved travel cost matrix
Accommodation 1. If travel is required on the day before or the day after the verification Invoiced at cost or in accordance with
Expense 2. If the verification requires 2 or more days to complete. pre-approved travel cost matrix
Liability Refer to CPS Conditions of Service. n/a
All services of Bureau Veritas Consumer Products Services Division are strictly offered, and can only
be accepted, under the CPS Conditions of Service. Any party that requests said services, confirms
said services, or makes any payment for said services does so agreeing automatically that: (a) it
irrevocably accepts and agrees to the CPS Conditions of Service; (b) it waives all rights to change or
CPS Conditions of
challenge the CPS Conditions of Service; and (c) the CPS Conditions of Service are final and, unless n/a
Service
expressly agreed otherwise by Bureau Veritas, any additional conditions sought to be imposed on any
service or payment shall be invalid. The CPS Conditions of Service can be accessed through this link:
http://www.bureauveritas.cn/BIMFSmtM/SD166_WI_BV_CPS_CONDITIONS_OF_SERVICE_REV03_
11DEC15.pdf
BV CPS will maintain all information gathered during the verification process and any related reports
Confidentiality
confidential at all times. Information will only be shared with pre-approved parties.
Prepayment is required for all invoice payers unless otherwise specified.
The credit terms of net 30 days from the invoice date may be offered to program clients based on the
Payment Terms size of the program as per BV senior management's approval. Late payment might result in a change n/a
of payment conditions from credit to prepayment.
Invoices are payable whether the product/shipment is accepted, rejected, shipped, or unshipped.
All services will be performed according to Company’s generic protocols / standard operating procedures should the client not provide their own specific requirements.
When invoices for Company’s Services are issued to parties other than the Client (agent, vendor, factory, etc.), the other party must meet local credit requirement for the
country where the invoice is issued, which may include partial prepayment or full prepayment. The Client will be notified of any unpaid invoices by their vendor/factory over
40 days from invoice date. The Company reserves the right to suspend services and/or change payment terms to full prepayment for Client’s account being overdue. All
remittance charges, commission & bank charges, telegraph transfer, and any particular country tax charges shall be strictly borne by the invoice recipient/remittance party.
**TO ENFORCE OUR INTEGRITY POLICY, WE MAY SEND MYSTERY VERIFICATIONORS TO PERFORM SERVICES AND REPORT ANY CASES OF
SUSPECTED BRIBERY TO THE LEGAL AUTHORITIES FOR FURTHER INVESTIGATION AND ACTION AS PER LOCAL LAW.”

IMPORTANT – THE APPLICANT MUST PROVIDE THE BOOKING FORM SIGNED, DATED AND CHOPPED ON ALL PAGES TO AVOID
POTENTIAL PROCESSING DELAY OR REJECTION.

CLIENT SIGNATURE _____________________________ COMPANY CHOP __________________ DATE _____________

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