Chemical Approval
Print GHS Label
Requestor Name:
Requestor Contact no:
Requestor email:
Department:
Date:
Product Name (per SDS):
Product Manufacturer (per SDS):
Synonym(s) (if known):
Product Ingredients (Per SDS)Product CAS RN (Per SDS)Product Composition (Per SDS) 
IODINE 7553-562 20%-30%
POTASSIUM IODIDE 7681-11-0 70% - 80%
GHS Classification (Per SDS)
GHS Signal words (Per SDS)
GHS PICTOGRAM (Per SDS)
Chemical Hazards (Per SDS)
Precautionary statement (Per SDS)
English SDS Upload:
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GOLD ETCH AU-1 Dry 01 Apr 2019.pdf
SDS Effective Date:
Chinese SDS Upload:
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GOLD ETCH AU-1_DRY Chinese 1 Apr 2019.docx
SDS Effective Date:
Flashpoint
Auto Ignition temperature
pH
Physical State
Classification
(Please specfiy if others)
Incompatibles listed on SDS
(Please specify if metals)
(Please specify if others)
Where will the chemical be used?
Describe the process the chemical will be used in
Estimated Quantity to be used per month
Container size:
Lumileds Part No:
Requestor's declaration for the below information are to his/her knowledge
1. Will the Chemical be retained on LUMILEDS' product?
2. Will the chemical be used as cleaning/demolder/degreaser?
Please attached the below document if applicable
a) Supplier Disclosure Form
*Please do not use @#$%^&*() to name your attachment.

b) Test Report/Supplier Declaration Form
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EHS Use Only
Licencing Requirement:
Does the chemical require license from regulatory body?
Agency:
(Please specify if others)
Other EHS Considerations:
EHS Approval:
Date:
Reason not approved:
EHS Remarks:
OTher EHS Considerations:
EHS Approval:
Date:
Reason not approved:
EHS Remarks:

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