Social Responsibility and Responsible Sourcing Home APPLICATION FORM FOR SOCIAL AUDITS (SMETA, etc) You must have JavaScript enabled to use this form. Authorisation GUIDANCE NOTE: The person who is filling in this form. Requested by (full name) Company Email address Section A - Audit details Code of Conduct / Standards Code of Conduct / Standards SMETA Others If others, please state Who requested you do this audit? Who requested you do this audit? AB InBev adm Alpla Amcor Associated British Foods Barry Callebaut Beiersdorf BEL Group Britvic Cargill The Clorox Company Coca-Cola Colgate-Palmolive Coty Creative Werks Danone Diageo Estee Lauder Ferrero General Mills Givaudan Heineken Henkel Hershey’s Kellogg’s Kimberly-Clarks L’Occitane Mondelez International Mars McCain Foods McDonald’s Nestlé Orkla Pepsico Procter & Gamble Pernod Ricard Reckitt Benckiser SC Johnson Unilever WestRoc Other Other Please add additional customers you want to share the report with (Optional) Do you intend to share the audit report with other client(s)? Yes No If yes, please state the client(s) Audit Notification Pattern Audit Notification Pattern Announced Semi-announced unannounced For SMETA audits only 2-Pillar 4-Pillar Sedex Virtual Assessment SGP FSA (SAI platform) Other SVA Pillar 2-Pillar 4-Pillar If Other, please state Audit Type Full Initial Audit Periodic Audit / Re-audit Full Follow Up Audit Partial Follow Up Partial Other Please Specify Expected Audit Date Final Report Distribution GUIDANCE NOTE: MASTER CLIENT NOMINATED IN THE BOOKING FORM EXPECTS THAT A FULL COPY OF THE ETHICAL REPORT IS MADE AVAILABLE TO THEM BY BUREAU VERITAS. PLEASE CHECK THIS BOX TO GRANT YOUR PERMISSION TO DO THIS. BY CHECKING THE BOX, THIS ALSO MEANS YOU ALLOW BUREAU VERITAS TO CONTACT ANY OF THE LISTED MASTER CLIENTS CHOSEN OR ADDED IN OTHER TO SHARE AUDIT AND SCHEDULING INFORMATION WITH THEM. BUREAU VERITAS WILL FOLLOW ANY SERVICE LEVEL AGREEMENTS WE HAVE IN PLACE WITH RETAILER/BRAND NOMINATED. (PLEASE NOTE: REQUESTS CANNOT BE PROCESSED WITHOUT THIS PERMISSION BEING GIVEN). Section B - Facility to be audited details Factory name Factory contact Factory Address State/city Zip/Post code Country Country Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Ceuta and Melilla Chad Chile China Christmas Island Clipperton Island Cocos [Keeling] Islands Colombia Comoros Congo - Brazzaville Congo - Kinshasa Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Denmark Diego Garcia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau SAR China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar [Burma] Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Outlying Oceania Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria São Tomé and Príncipe Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Outlying Islands U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands Factory contact Telephone Factory Contact Fax Factory Province Factory Email Description of products/Services Are you Service Provider for your Master client Yes No Are HR, working hours & payroll records held onsite? Yes No Not Sure If No, please provide details/address of where these documents are held Employee Information (At site to be audited) Permanent (Employed directly) Male Female Temporary Male Female Agency Male Female Home Workers/Outworkers Male Female Number of shifts Please list the different languages that are spoken by employee on site Existing Certificates Existing Certificates SA 8000 ISO 14001 ISO 45001 RBA SMETA 2 pillers SMETA 4 pillers SGP URSA SWA FSA (SAI platform) Others Sedex member Sedex member Yes No Sedex codes (ZC# & ZS#) Others platform upload name and membership codes (ARAVO, COSMOS, Rizepoint, etc.) Date Sedex SAQ was last updated Other comments I agree to receive marketing communications from Bureau Veritas Certification I agree to the terms of service. 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