Audit/Verification Application Form

Audit/Verification Application Form (CM/GSV/MQP/SQP/TGI/WCA)
审核申请表

Section 1: Service Request 审核需求:
Intertek Community’s Recommended Programs 推荐方案:
0
Global Security Verification - GSV An evaluation on facility’s security procedures and systems in accordance with U.S. Government and other supply chain security requirements
0
Supplier Qualification Program - SQP An evaluation on supplier’s quality management system, product control, process control, etc.
X0
Workplace Conditions Assessment- WCA A social compliance audit aligned with industry standards and best practices to improve working conditions in supply chain
Food Supplier Best Practices Audit -SBP An evaluation of a facility’s food safety, security and quality systems
Audit Type 审核类型: 0 Initial Audit 初次审核
0 Follow-up Audit 跟进审核
0 Annual Audit / Renewal Audit 年度审核
0 Others 其它

Audit is being requested for (MUST ANSWER): 0 Direct Import
0 Domestic

Desired Audit date (DD-MM-YYYY) 要求审核日期:

Section 2: Information of Applicant申请方信息:
Company Name
(English & Local Language)
公司名称(中英文) English VIET TIEN PHU GARMENT TRADING MANUFACTURING CO., LTD.
Local
Address
(English & Local Language)
地址(中英文) English 68 TAN THOI NHAT 8 STR., TAN THOI NHAT WARD, 12 DISTRICT, HCM CITY,VN.
Local
Contact Person ‘s Name/Title联系人 Telephone Number联系电话
Fax Number 传真号码 E-mail address电子邮件

Section 2a: Information of Vendor (If applicable) 中间商信息(如适用):
Company Name
(English & Local Language)
公司名称(中英文) English
Local
Address
(English & Local Language)
地址(中英文) English
Local
Contact Person ‘s Name/Title联系人 Telephone Number联系电话
Fax Number 传真号码 E-mail address电子邮件



Section 3: Invoiced Details付款方信息(如与申请方信息相同，可不填)
Company Name
(English & Local Language)
公司名称(中英文)
Address
(English & Local Language) 地址(中英文)
Contact Name 联系人
Telephone Number 联系电话
Fax Number (For billing) 传真号码
E-mail address 电子邮件

Section 4: Details of Physical Facility to be assessed被审核企业资料:
Company Name
(English & Local Language) 公司名称(中英文) English
Local
Address
(English & Local Language) 地址(中英文) English
Local
Contact of Facility Representative & Title企业联系人及职衔 Telephone Number联系电话
E-mail address电子邮件 Fax Number传真号码
Contact of Facility’s Top Management 企业管理层联系人 Web Site 网站
Year of Facility Established 成立年份 Facility Business License/Permit Number 营业执照号码
Facility Business License/
Permit valid up to (If applicable)
(DD-MM-YYYY) 营业执照有效期 : Facility Business License/Permit is issued by 营业执照签发机构:
Product Classification of Manufacturing 产业类型
0 Home communications, entertainment and hobby equipment
家庭通信，娱乐和嗜好设备
0 Furniture and Furnishings家具和家居
0 House appliance家电
0 Housewares (non-powered)
家庭用品（非电动）
0 Chemicals and chemical products
化学品及化学产品
0 Home workshop apparatus and tools
家庭工作坊仪器和工具
0 Yard and garden 园艺设备
0 Child nursery equipment and supplies
儿童设备和用品
0 Personal use items 个人用品
0 Garments, Footwear and Accessories
服装，鞋类及配件
0 Sports and Outdoor Recreation Equipment 体育和户外游乐设备
0 Packaging and Containers 包装和容器
0 Toys 玩具
0 Personal care items 个人护理用品
0 Auto Part & Accessory 汽车零部件及配件
0 Beverage & Food 饮料食品
0 Pet related products 宠物相关产品
0 Medicine 医药
0 Raw Material 原材料
0 Miscellaneous Products 杂项
0 Servicing Facilities 服务行业
0 Other 其他________________

Main Product(s) (please specify) 主要产品（请注明）: Total No. of Employees雇员人数
Main Language of employees员工的主要语言 Production Workers 生产工人
Management Staff 管理人员
Facility Size
企业面积
Facility Land Size (m2)
企业用地面积（平方米）
Total Facility Floor Size (m2)
企业总楼面面积（平方米）
Number of Buildings 建筑物数目 Production 生产
Dormitory 宿舍
Warehouse 仓库
Other (please specify) 其他（请注明）



Section 5: This Part is for GSV Only 本部分仅适用于GSV

Yes No
Are warehouse(s) customs bonded? 是否属于海关保税仓库? 0
0

Are facilities located in a Free-Trade Zone? 企业是否位于自由贸易区/保税区? 0
0

High Value Parts 是否高额保值产品? 0
0

Hazardous Materials 是否或含有危险原料? 0
0

Perishables 是否易腐烂的产品? 0
0

Chemicals 是否化学品? 0
0

Munitions / Dual Use 是否军需品? 0
0


Section 6 Quotation and Confirmation by Intertek Intertek 报价确认
Proposed Date of On-site Audit: (DD-MM-YYYY) 确认审核日期 Manday Required 人天:
Audit Fee 审核费: Approximate Cost of Travelling & Accommodation 差旅费
Date of Quotation 报价日期: (DD-MM-YYYY)

Section 7: Declaration of Consent同意声明 (For CM/GSV/MQP/SQP/TGI/WCA)
1. The goal of the CM, WCA, GSV, TGI, MQP and SQP Programs are to help the manufacturing and export community eliminate redundant assessment/audits. Manufacturers/facility that voluntarily choose to participate in these Program agree to an on-site independent assessments/audits, to measure and verify how well their operation/management system meet the standards outlined in the programs. By signature below, the Applicant agrees and authorizes Intertek to share the audit results (when the facility has met the requirement of granting Achievement Award / ROP) with our GSCC members where the facility currently or plans to produce merchandise for sale, as evidence of accomplishing supply chain obligations.
CM, WCA, GSV, TGI, MQP and SQP的目的是帮助制造商和进口商减少重复检验。自愿选择参加这些计划的制造商同意接受独立的现场检验/审核，来衡量和检验其经营/管理系统如何满足在计划中概述的标准。在文件以下部分签字后，申请人同意并授权Intertek将审核结果 (当被审核的企业已符合授予成就奖/参与证明的要求时)与我们的GSCC成员分享包括申请人目前或计划为其销售而生产商品的机构，作为履行供应链责任的证明。
2. The Applicant agrees that Intertek will list the Achievement Award / ROP information i.e. company name, registration number, award number, date of award, and expiry date etc. on the Achievement Award / ROP directory which will be posted on the related website for the programs.
申请人同意Intertek在方案的相关网站上张贴成就奖/参与证明的信息，包括公司名称、注册号、奖项号码、审核日期和到期日等。
3. If the Applicant is not the physical audited facility where the audit takes place (for example, the buying agency applies the audit/assessment on behalf of supplier production site) 如果申请人并非实际被审核的企业，（例如，采购代理代表生产供应商申请审核/评估）:
a) it is the responsibility of Applicant, prior to apply this audit, to seek the permission from the facility to be audited for above report sharing activities申请本次审核前，申请人有责任向被审核的企业，寻求上述报告共享活动的许可
b) the Applicant agrees a copy of report and physical Achievement Award / ROP(if any) will be issued to the actual facility audited.
申请人同意Intertek向上述实体企业出具报告和成就奖/参与证明。

Section 8: Special Disclaimer 特别免责声明
Applicant/Client/Facility to be assessed (“Facility”) hereby agrees that, notwithstanding Intertek’s obligations of providing audit reports on basis of true finding and its confidentiality obligation on information received in audit process hereunder or under any other audit service agreement or terms and conditions, in case that Facility conducts or attempts to conduct improper activities to hamper, influence or interference on the audit process or result, including but not limited to tamper with or force Intertek to change the audit result by means of violence, threat and illegal restriction of personal freedom ("Improper Influence Activities), Intertek issuance of such tampered or changed audit report due to Improper Influence Activities (“Influenced Report”) shall not be deemed as any breach of Intertek’s obligation of providing audit report based on true finding, and Intertek shall be released from its confidentiality obligation to:
申请人/客户/被审核人（“被审核人”）特此同意，尽管Intertek在此或根据其他审核协议或任何条款与条件有义务出具符合事实的审核报告，并对因审核而获知的相关信息负有保密义务，但如果被审核人有任何阻止、影响、干扰或试图阻止、影响或干扰审核过程或审核结果的不当行为，包括但不限于以暴力、威胁、非法限制人身自由等手段影响审核过程、篡改或迫使Intertek修改审核结果的行为（“不当影响行为”），则Intertek因不当影响行为而发出此等被篡改的或被迫修改的报告（“被不当影响的报告”）不视为Intertek违反真实审核义务，且Intertek有权不受保密义务约束而采取以下行动：

1. provide an audit report based on true finding to replace and correct the Influenced Report(if already issued);
以随后发出的符合事实的审核报告取代、纠正已发出的被不当影响的报告（如已发出）；
2. report the Improper Influence Activities to the supervising authorities of Intertek and/or of the Facility, including but not limited to reporting the threats, violence and other illegal activities of Facility to public security authorities;
向有关Intertek及/或被审核人监管部门或其他相关部门举报不当影响行为，包括但不限于向公安部门报告被审核人的暴力、威胁等违法行为；
3. inform related third parties including but not limited to the buyers, business partners of the Facility, recipient of the audit reports, etc, of the Improper Influence Activities;
向相关第三方，包括但不限于被审核人的买家、业务伙伴、审核报告的接受方等告知不当影响行为；
4. terminate the audit agreement unilaterally reserving the rights of pursuing service fee and claiming any damages incurred by Intertek; and
终止审核协议，要求支付审核费用并就Intertek所有损失提出索赔；及
5. conduct any other activities or actions which are reasonably necessary for protection of legal interest of Intertek, safety of its employees or the reliability of its audit result.
为保护Intertek人员安全、