DOC Request for the scope of certification

(1)

Year.……. month……. date……

Request for the scope of certification for manufacturer To Director of PT. Mutuagung Lestari

Applicant name Head Office Address

We, under the provision of Article 19-3 paragraph 1 of the law concerning Standardization and Proper Labeling of Agricultural and Forestry Products (Law No. 175 in 1950) hereby, make a request for the scope of certification as follows because we intent to obtain a certification as to what we indicate the grading.

1. The denomination, the address and responsible person’s

name of the

manufacturing plant

Factory name : Factory address :

Responsible

person :

Position :

3. The name of contact person who takes charge of the certification

Name :

Position :

Email :

Phone number : 5. The kinds and

classification of the agricultural and

Category : Plywood

Item product : Please tick the box by double click

& select checked

(2)

forestry products

intended for

obtaining the

certification

Plywood for general use (OP)

Plywood for general use with insect control treatment

Concrete formwork plywood (CP)

Concrete formwork plywood, low formaldehyde emission

Concrete formwork plywood, surface finished Concrete formwork plywood, surface finished, low formaldehyde emission

Structural plywood (SP)

Structural plywood with insect control treatment Structural plywood, low formaldehyde emission Structural plywood with decorative processing Natural wood decorative plywood (NWDP)

Natural wood decorative plywood with insect control treatment

Specially processed decorative plywood (SPDP) Specially processed decorative plywood with insect control treatment

Note: the detail of item products can be seen in the attachment below

9. The estimated

quantity of output and the estimated volume of graded products and the estimated volume of products indicated the grading 1 year, after the submission of such certification

Item

The estimated quantity of output in 1

year

The estimated volume of

exported products in 1

year

The estimated volume of JAS graded products

in 1 year

10. How to get the mill by transport

11. Our office mailing address

Address :

Person in

charge :

Email :

Phone

number :

15. Our office address for Address :

Person in :

(3)

invoice delivery

charge

Email :

Phone

number :

19. Legal business license

Company Registration / Tanda Daftar Perusahaan (TDP) /

Nomor Induk Bersama (NIB) Nomor Pokok Wajib Pajak (NPWP) Others:………

20. Purpose of certification

New Application / Factory Additional item products Additional resin/wood species Others:

Detail of the scope of certification Name of Factory:

Category Item product Detail of the scope

Check list for the reference

1. Facility of Manufacturing, Storage and Quality Control

Item Judgem

ent Note

Manufacturing facility

Storage facility

Quality Control

(4)

facility

2. Organization and implementation method of Quality Control (QC)

Item Judgem

ent Note

Criteria for QC

Implementation of QC

Result of QC

3. Qualification and the number of persons in charge of Quality Management (QM)

Item Judgem

ent Note

Persons in charge of

QM Number of persons : (Qualification :

Have / Not have) Responsible person

in QM Number of persons : (Qualification : Have / Not have)

Persons in charge surface quality inspection

Number of persons : (Qualification : Have / Not have)

4. Organization and Implementation methods of grading

Item Judgem

ent Note

Organization of grading

Implementation method of grading Organization that entrust the test for grading

Organization :

Agreement of entrusting : PT Mutuagung Lestari

5. Qualification and the number of persons in charge of grading

Item Judgem

ent Note

Person in charge of

grading Number of persons : (Qualification : Have / Not have)

Note

: In check list forth reference, would judge your self by “Technical Criteria for certification of Manufacturers”.

Judgment: OK or Not OK (NOK)

Declaration

We have read the ROCB “Code of Practice for the Certification” and We agree

to fulfill ROCB Certification requirement based on Code of Practice for the

Certification.

(5)

Nam

e : Signature: Date:

Positi on

:

ROCB office use only

1. Scope of certification : ^Available Not available 2. Competence and

capability to perform the certification activity :

Available Not available

3. Tools for certification

services : ^Have ^{Not have}

4. Differences of

Understanding between

ROCB and client :

Have Not have

5. Refer to point 4, if there is any differences,

please inform the status :

Finished Not finished

6. Conflict of interest and

impartiality : ^Have ^{Not have}

Reviewed by

: Signature:

Date :

Decision : _Continue Not Continue

Reason:

(6)

Details of “Plywood for General Use (OP)”

To PT Mutuagung Lestari

Name of factory:………. New application Additional item product Additional wood / resin / others

No Type of Bonding

quality

Kind of core (veneercore/VC

or lumbercore/LC)

Emission

class Kind of resin

Wood species Catcher method on finished goods,

if any

Thickness range (mm) & number

of plies

Method of

Process Insecticide treatment F/B Core Centercore/

Lumbercore 1 OP T-1

OP T-2

VC LC

F☆☆☆☆

F☆☆☆

UF MUF MF PF / WBP Others:………….

Number of supplier:

…..

Supplier: ………..

No use Coating Spray If use: …………...

Brand: …………...

Supplier:

…………...

Ply: 3

Thinnest: …………

1x process 2x process

No use Boron Fenitrothion Bifenthrin Cyphenothrin Ply: 5

Medium: ………….

1x process 2x process Ply: ………..

2 OP T-1 OP T-2

VC LC

F☆☆☆☆

F☆☆☆

UF MUF MF PF / WBP Others:………….

Number of supplier:

…..

Supplier:

………..

No use Coating Spray If use: …………...

Brand: …………...

Supplier:

…………...

Ply: 3

No use Boron Fenitrothion Bifenthrin Cyphenothrin Ply: 5

Note: please select and tick the box by double click and click “checked”

Kind of resin: Wood species, examples:

1. UF: Urea Formaldehyde Wood species, examples:

MLH: red/yellow/white meranti, mersawa, etc

Keruing, Kapur, Poplar, Eucalyptus, Mahoni, Rubberwood Falcata, Jabon, Mahoni, Pine, Larch, etc

2. MUF: Melamine Urea Formaldehyde 3. MF: Melamine Formaldehyde 4. PF: Phenol Formaldehyde

5. Others: such as PVAc, Polymer Isocyanate, etc

(7)

Details of “Concrete Form Plywood (CP)”

To PT Mutuagung Lestari

Name of factory: ………. New application Additional item products Additional wood / resin / others

No Surface

Processing, if any

Number of surfaces processing

Emission class

Bending stiffness

direction Kind of resin

if any

Thickness range (mm) & number of

plies

Method of Process F/B Short

core Center core 1 No process (CP)

Coated (UCP) Overlaid (FF)

N/A 1 Face 2 Face

F☆☆☆

F☆☆

F☆

Regular

Length Width Both

MUF MF PF / WBP Others:…………

Number of supplier:……..

Supplier: ……….

No use Coating Spray If use:

Brand: ………

Supplier: ………

Ply: ………..

Thinnest: ………

Medium: ……….

Thickest:

……….

1x process 2x process 2 No process (CP)

Coated (UCP) Overlaid (FF)

N/A 1 Face 2 Face

F☆☆☆

F☆☆

F☆

Regular

Length Width Both

MUF MF PF / WBP Others:…………

Number of supplier:……..

Supplier:

……….

Brand: ………

Supplier: ………

Ply: ………..

Thinnest: ………

Medium: ……….

Thickest:

……….

Note: please select and tick the box by double click and select “checked”

Kind of resin: Wood species, examples:

MLH: red/yellow/white meranti, mersawa, etc

Keruing, Kapur, Poplar, Eucalyptus, Mahoni, Rubberwood Falcata, Jabon, Mahoni, Pine, Larch, etc

1. MUF: Melamine Urea Formaldehyde 2. MF: Melamine Formaldehyde 3. PF: Phenol Formaldehyde

(8)

Detail of “Structural Plywood (SP)”

To PT Mutuagung Lestari

Name of factory: ………. New application Additional item products Additional wood / resin / others

No

Type of Bondin

g quality

Class of

bending Emission

class Kind of resin

if any

Thickness range (mm) & number

of plies

Method of

Process Insecticide treatment F/B Core Center Core

1 T-1 T-S

C-1 C-2

F☆☆☆☆

F☆☆☆

Regular

MUF MF PF / WBP

Others:……….

Number of supplier:

……..

Brand: ………

Supplier: ………

Ply: ………..

No use Boron Fenitrothion Bifenthrin Cyphenothrin Ply: ………..

Medium:

…………..

Thickest: ………….

1x process 2x process 2 T-1

T-S

C-1 C-2

F☆☆☆☆

F☆☆☆

Regular

MUF MF PF / WBP

Others:……….

Number of supplier:

……..

Brand: ………

Supplier: ………

Ply: ………..

No use Boron Fenitrothion Bifenthrin Cyphenothrin Ply: ………..

Medium:

…………..

1x process 2x process Note:

please select and tick the box by double click and select “checked”

Kind of resin: Wood species (minimum Engelmann spruce density min: 0.37 gr/cm³ or 370 kg/m³), examples:

1. MUF: Melamine Urea Formaldehyde

2. MF: Melamine Formaldehyde MLH: red/yellow/white meranti, mersawa, etc

3. PF: Phenol Formaldehyde Keruing, Kapur, Poplar, Eucalyptus, Mahoni, Rubberwood, Mahoni,

4. Others, examples PVAc, PI, etc Pine, Larch, etc

(9)

Detail of “Decorative Structural Plywood (Decorative SP)”

To PT Mutuagung Lestari

Name of factory: ………. New application Additional item products Additional wood / resin / others

No

Type of Bondin

g quality

Emission class

Kind of resin for decorative

bonded

Species of decorative veneer

Number of surfaces of decorative veneer

Catcher method on finished goods,

if any

Insecticide treatment

Base material (SP)

Description Detail

1 T-1 T-S

F☆☆☆☆

F☆☆☆

Regular

MUF MF PF / WBP Other:…………

Number: ………….

Supplier:

…………

Species:

………….

Thick:

………

1 Face 2 Faces

Brand: ………..

Supplier: …………..

No use Boron Fenitrothion Bifenthrin Cyphenothrin

Kind of resin

MUF MF

PF / WBP

Others:………

Number of plies

3 Ply 5 Ply

7 Ply 9 Ply Supplier

………

…

JAS Factory Non JAS Factory 2 T-1

T-S

F☆☆☆☆

F☆☆☆

Regular

MUF MF PF / WBP Other:…………

Number: ………….

Supplier:

…………

Species:

………….

Thick:

………

1 Face 2 Faces

Brand: ………..

Supplier: …………..

No use Boron Fenitrothion Bifenthrin Cyphenothrin

Kind of resin

MUF MF

PF / WBP

Others:………

Number of plies

3 Ply 5 Ply

7 Ply 9 Ply Supplier

………

JAS Factory Non JAS Factory Note: please select and tick the box by double click and select “checked”

Kind of resin: The thickness species for decorative veneer must be

less than 1 mm. Wood species of base material (minimum Engelmann spruce density min: 0.37 gr/cm³ or 370 kg/m³) 1. MUF: Melamine Urea Formaldehyde

2. MF: Melamine Formaldehyde The wood species, examples:

3. PF: Phenol Formaldehyde Birch, Beech, Red/White Oak, Teak, Walnut, etc 4. Others: such as PVAc, Polymer Isocyanate, etc

(10)

Details of “Specially Processed Decorative Plywood (SPDP)”

To PT Mutuagung Lestari

Name of factory: ………. New application Additional item product Additional wood / resin / others

No Type of Bonding

quality Emission class Type of processing

Number of surfaces

Surface performanc

e

Kind of resin for decorative

bonded

Catcher method on finished

goods, if any

Thickness range

(mm) Base material Insecticide

treatment 1 OP T-1

OP T-2

F☆☆☆☆

F☆☆☆

Overlaid Polyester Painted

1 Face 2 Faces

F type FW type W type SW type

UF MUF MF PF / WBP Others: ……….

Supplier: …………

Brand:

…………

Supplier:

………

OP Veneer Core (Plywood) Supplier:

………

JAS Factory Non-JAS

No use Boron Fenitrothion Bifenthrin Cyphenothrin OP Lumbercore (Blockboard)

Supplier:

………

JAS Factory Non-JAS 2 OP T-1

OP T-2

F☆☆☆☆

F☆☆☆

Overlaid Printed Painted

1 Face 2 Faces

F type FW type W type SW type

UF MUF MF PF / WBP Others: ……….

Brand:

…………

Supplier:

………

JAS Factory Non-JAS

Supplier:

………

JAS Factory Non-JAS

(11)

Note:

please select and tick the box by double click and select “checked”

Kind of resin: Surface performance

1. UF: Urea Formaldehyde F type: used mainly for table top, counter or the like

2. MUF: Melamine Urea Formaldehyde FW type: used mainly for load bearing walls of architectural and used for furniture as well 3. MF: Melamine Formaldehyde W type: used mainly for walls of architectural structure in general

4. PF: Phenol Formaldehyde SW type: used mainly for special walls of architectural structure 5. Others: such as PVAc, Polymer Isocyanate,

etc

Details of “Natural Wood Decorative Plywood”

To PT Mutuagung Lestari

Name of factory: ………. New application Additional item product Additional wood / resin / others

No Type of Bonding

quality Emission class Wood species of decorative

veneer

Number of

surfaces Kind of resin Catcher method on finished goods,

if any

Thickness range

(mm) Base material Insecticide

treatment 1 OP T-1

OP T-2

F☆☆☆☆

F☆☆☆

Species:

……….

Thick:…………

1 Face 2 Faces

UF MUF MF PF / WBP Others: PVAc Supplier:

………..

Brand:

………

Thinnest: ………

Medium: ……….

Thickest:

……….

………

JAS Factory Non-JAS

Supplier:

………

JAS Factory Non-JAS 2 OP T-1

OP T-2

F☆☆☆☆

F☆☆☆

Species:

………. 1 Face

2 Faces

UF MUF MF PF / WBP

No use Coating Spray

Thinnest: ………

Medium: ……….

Thickest:

……….

………

JAS Factory Non-JAS

No use Boron Fenitrothion Bifenthrin

(12)

Thick:………… Others: PVAc Supplier:

………..

If use:

Brand:

………

Cyphenothrin OP Lumbercore (Blockboard)

Supplier:

………

JAS Factory Non-JAS Note: please select and tick the box by double click and select “checked”

Kind of resin: Wood species of decorative veneer, examples:

1. UF: Urea Formaldehyde Birch, Beech, Red/White Oak, Teak, Walnut, etc 2. MUF: Melamine Urea Formaldehyde

3. MF: Melamine Formaldehyde 4. PF: Phenol Formaldehyde