NB-Collectors annual statement

Address *

Amongst the following products, which one(s) were you registered for as a UOMA NB collector? *

Used oils Used antifreeze Used filters Used oil and antifreeze containers Used aerosol containers

Please indicate the used oil quantities your company had in inventory at the following dates. *

	January 1st 2018	December 31st 2018
Quantity (L)

Please indicate the used antifreeze quantities your company had in inventory at the following dates. *

	January 1st 2018	December 31st 2018
Quantity (L)

Please indicate the used filters quantities your company had in inventory at the following dates. *

	January 1st 2018	December 31st 2018
Quantity (kg)

Please indicate the used oil and antifreeze containers quantities your company had in inventory at the following dates. *

	January 1st 2018	December 31st 2018
Quantity (kg)

Quantity of UOMA NB used oil and antifreeze containers collected over the last year (in kg) *
Total quantity of used oil and antifreeze containers collected over the last year (in kg) *

Please indicate the used aerosol containers quantities your company had in inventory at the following dates. *

	January 1st 2018	December 31st 2018
Quantity (kg)

Quantity of UOMA NB used aerosol containers collected over the last year (in kg) *
Total quantity of used aerosol containers collected over the last year (in kg) *

Signatory name *
Signatory title *
Email address *
I, {signatoryName}, {typeA} confirm the information provided on this form is accurate and I recognize it could be subject to audits. The detailed files supporting this claim are available for consultation upon request.
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Date *

- Month - Day Year
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UOMA NB Collectors annual statement