Example Company Ltd Duty of Care Waste Transfer Note:

[LOGO]
15/03/2025
PART A Notification Details
Consignment Note Code EXESTR / EXA042
The waste described below is to be removed from:
123 Business Park, Industrial Estate, Manchester, M1 2AB
The waste will be taken to
Example Company Ltd
Unit 5, Recycling Park
Green Lane
Bristol
BS1 1AA
Premises code (where applicable):
E
X
E
M
P
T
STR Internal Ref:
C
O
L
L
4
2
PART B Description of Waste
The process giving rise to the waste(s) was:
SIC for the process giving rise to the waste:
7
2
6
0
Description of waste: List of waste (EWC Codes) QTY(KG) Physical Form
GEN WEEE 1 6 0 2 1 4 450 SOLID
PART C Carriers Certificate

I certify that I today collected the consignment and that the details in parts A and B are correct and I have been advised of any specific handling requirements.

Carrier Name: Example Company Ltd
Unit 5, Recycling Park
Green Lane
Bristol
BS1 1AA
Carrier registration no. /reason for exemption:
CBDU123456
Vehicle registration no:
AB12 CDE
Signature: [DIGITAL SIGNATURE]
Date: 15/03/2025
Time: 14:30
PART D Consignor's certificate

I certify that the information in A, B and C above is correct, that the carrier is registered

Signature: [CUSTOMER SIGNATURE]
Date: 15/03/2025
Time: 14:30
Consignor Name:
John Smith
Office Instruction:
Standard collection
Driver Instruction:
Use rear entrance
PART E Disposer of waste
1. I received this waste at Example Company Ltd
Date: 15/03/2025
Time: 16:45
2. Vehicle Registration Number: AB12 CDE
Name: Mike Johnson

I certify that waste management licence:

authorises the management of the waste
described in B at Example Company Ltd.
Company Reg: 12345678

On Behalf of Example Company Ltd
Unit 5, Recycling Park
Green Lane
Bristol
BS1 1AA
0117 123 4567
Signature: [DIGITAL SIGNATURE]
Date: 15/03/2025
Time: 16:45