Company Information

Company Registered Name *	Company Trade Name
DFFE (SAWIC) Producer Registration No *	Company Registration No *
Country of Registration *	Year Established *

Physical Address

Company Physical Address *	Company Street Name *
Company Suburb/City *	Company Postal Code *
Company Province	Company Country *
Postal Address differs from Physical Address? Yes No	Billing Address differs from Physical Address? Yes No	Postal Address * Postal Street Name * Postal Suburb/City * Postal Code * Postal Province Postal Country *	Billing Address * Billing Street Name * Billing Suburb/City * Billing Postal Code * Billing Province Billing Country *
Company Telephone Number *	Website Address
Place of Trade/Manufacture	Industry Sector *
Type of EEE Producer Brand Owner Importer Licensed Agent Manufacturer Refurbisher/Reseller Retailer

Legal Compliance Manager

This person is responsible for the company's regulation/compliance function.

First Name *	Surname *
Contact No *	Email Address *

Executive Director/Contract Signatory

This person will sign the ERA NPC Producer Contract

First Name *	Surname *
Contact No *	Email Address *

Reporting Official

This person will upload/input the Producer's monthly PoM reporting data

First Name *	Surname *
Contact No *	Email Address *

Accounting Official

First Name *	Surname *
Contact No *	Email Address *

Marketing Manager

First Name *	Surname *
Contact No *	Email Address *

Financial Compliance Information

VAT Number *

Financial Year End (month) *

EPR Compliance

Do you currently pay EPR fees?* Yes No

Do you currently belong to a PRO?* Yes No

Which PRO do you belong to?*

What is your current annual place (weight) on the market? (this will be used for your membership invoice) Under 100kgs 100 – 1,000kgs 1,001 – 5,000kgs 5,000 – 10,000kgs Over 10,000kgs

Current WEEEL Recycling

Describe WEEEL Management Method(s)*

WEEEL Management Service Provider Name

Estimated Annual WEEEL Tonnage Processed

Direct Processing *

Via Service Provider(s)

Document Uploads

Person Completing this Form

First Name *	Surname
Designation *	Contact Number *	Email Address *
I acknowledge that for ERA to complete my registration, my company will be sent an invoice for a once-off Membership fee for which we will be requested to make payment. ERA will also require my company to sign a master producer agreement.*
I acknowledge that my registration as a Producer member will only be completed once payment for this has been completed and the master producer agreement has been signed.*
I confirm that I am an authorised representative of the above company and confirm that the information provided on this form is true and correct at date of submission.*
Your Membership No.