Simplified Conflict Minerals Reporting Template (CMRT)

Section 1: Company Information

  • Company Name: ____________________________
  • Contact Name: ____________________________
  • Contact Email: ____________________________
  • Scope of Report: ____________________________ (e.g., specific products or supplier categories)

Section 2: Conflict Minerals Policy

Our company is committed to sourcing materials responsibly and complying with applicable regulations regarding conflict minerals. We request that suppliers ensure their products are conflict-free and provide the required sourcing information.

Section 3: Supplier Declaration

  1. Do the products supplied contain any of the following minerals: tin, tantalum, tungsten, or gold (3TG)?
    • Yes
    • No
  2. If yes, please provide the following information:
    • Name of Smelter/Refiner: ____________________________
    • Country of Smelter/Refiner: ____________________________

Section 4: Geographic Sourcing

  1. Are materials sourced from the Democratic Republic of Congo (DRC) or adjoining regions?
    • Yes
    • No
  2. If yes, have you conducted due diligence to ensure responsible sourcing?
    • Yes
    • No

Section 5: Certification

I certify that the information provided is accurate to the best of my knowledge.

  • Name: ____________________________
  • Title: ____________________________
  • Date: ____________________________

 

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