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Responsible Minerals Initiative (RMI) Form

MBE-61 REV 16OCT2025
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Responsible Minerals Initiative (RMI) Form

FORM👤 Tulika L📅 May 27, 2026
MBE-61 REV 16OCT2025
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General Section ▾
01. Vendor or Customer Name
Mary Smith
02. EIN #
CUST-78322
Company Information ▾
03. Company Name *
Nova Components LLC
04. Tax ID # *
78-3220145
05. DUNS #
07-842-1196
06. Company address
1200 Industrial Way, Bellingham, WA 98226
Conflict-Minerals Declaration ▾
07. Do your products contain 3TG (tin, tungsten, tantalum, gold)?
Yes
No
08. Full smelter list / CMRT provided?
Yes
No
09. Responsible-sourcing policy in place?
Yes
No
10. Country of origin identified?
Yes
No
Acknowledgement ▾
11. Authorized signatory
Mary Smith
12. Title
Compliance Manager
13. Date
27-05-2026
AI Supplier Review Live
Fields checked
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What Knowella found in this supplier record RMI Form · Nova Components LLC
✓
EIN & Tax ID validated against the business registry
CUST-78322 · 78-3220145 matched.
✓
Conflict-minerals CMRT & smelter list attached
3TG disclosed · responsible-sourcing policy on file.
!
Insurance certificate expires within 30 days
Renewal request drafted to the supplier.
✓
Company information complete (Nova Components LLC)
Address, DUNS & Tax ID captured.
✓
Authorized signatory captured
Mary Smith · Compliance Manager.
✦ Knowella AI
✓
Insurance renewal requested from Nova Components
Supplier verified · RMI declaration complete
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