AF-PSL-01 Audit Application Form

Applicant Company Name Address & Postcode Contact Name Contact Title Contact E-mail Address Contact Tel. Number

Supplier Company Name Address & Postcode Contact Name Contact Title Contact E-mail Address Contact Tel. Number

Announcement Type Audit Type Last Audit Date Preferred Audit Date / Window Unavailable Dates

Factory Name Legal Site Address & Postcode Actual Operation Address & Postcode Factory Website & GPS Position Type of Legal Status Date of Establishment Facility Land Size (m2) Number of Buildings/Sheds Primary Contact Name Primary Contact Title Primary E-mail Address Primary Tel. Number Secondary Contact Name Secondary Contact Title Secondary E-mail Address Secondary Tel. Number

Main Products Main Raw Materials / Supplied Parts Main Manufacture / Service Processes Subcontractor Processes Valid Certificate or Audit Report Self-assessment Completed? Dormitory Available? Language Spoken by Management Team Worker Languages and Proportion Employment Structure Foreign / Domestic Migrant Workers Shift Count Each Shift Start and End Break Time Weekly Holidays

Name & Designation Date