Company Name *

Packaging types produced* (e.g. Carrier bags, food trays, drums and bottles)

Registration Number *

VAT Number *

Physical Address *

Postal Address *

Telephone Number *

Contact Person *

Designation *

Email Address *

Accounts Dept Email *

Cell Phone Number *

Polymers Types * :
 HDPE
 LLDPE
 LDPE
 PP

Where do you source your polymer? *
 Sasol
 Safripol
 Plastomark
 Imports

Have you registered as a Producer with DEA? *
 YES, my organisation has registered with DEA as Producer
 NO, my organisation has not yet registered with DEA but do INTEND to

Ensure you are kept informed by Polyco+ of pertinent information with regards to the development of the Polyolefin Packaging Industry Waste Management Plan.
 YES
 NO

Acknowledgement :
By completing and signing this Polyco+ Stakeholder Registration form, I am signalling my organisation’s intent to be subscribed to the Polyco+ Industry Waste Management Plan for the Polyolefin Plastics Packaging Sector.