Please Send a Copy of This Request To

Certification request product in the field of fire prevention

CERT BOSEC P PROC 001 GENERAL RULES F WD 001 CUSTOMER REQUEST E V1

Please send a copy of this request to: ANPI Division Certification – [email protected]

Reserved for the administration

1. Applicant:

Already possesses a convention in the domain BOSEC FD P:

The convention number is:

Informs about the modification of the data given in the tables underneath

Does not possess a convention

NAME COMPANY:

STREET, NR:

POSTAL CODE, PLACE:

COUNTRY:

NAME CONTACT:

FUNCTION CONTACT:

EMAIL:

VAT NR:

The invoices for the certification costs have to be addressed to (if different from above):

NAME COMPANY:

STREET, NR:

POSTAL CODE, PLACE:

10675 1/13 ©ANPI Certification request product in the field of fire prevention

COUNTRY:

EMAIL:

VAT NR:

Appoints the following person to represent him/her for all questions with relation to the study of this request:

NAME CONTACT:

FUNCTION CONTACT:

COMPANY (IF DIFFERENT)

POSTAL CODE, PLACE:

COUNTRY:

EMAIL:

Declares that the above-mentioned company (tick the appropriate box(es)):

has the industrial ownership (patent-rights)

has an exploitation licence

restricts itself to put the product on the market

manufactures the product by licensed companies, submitted to his control and mentioned by name in the list in annex entrust the placement to licensed companies, submitted to his control and mentioned by name in the list in annex

Makes the commitment

- to complete his file, if necessary, on the request of the Certification body, by giving all the information and testing justification pieces in order to allow the technical evaluation of the fabrication as well as the implementation of the system/components characteristics and properties;

- to respect the certification rules BOSEC and the prevailing conditions of the certification. He also declares to accept the certification costs.

Authorizes the laboratories, that carried out the tests, to report all complementary information that could be asked within the framework of the file examination (reports enclosed).

2. Request

A component certificate based on the following test report(s):

A system certificate (EN54-13) based on the following test report(s):

The renewal of the component certificate .

The renewal of the system certificate (EN54-13) .

The extension of the component certificate .

The extension of the system certificate (EN54-13) .

The modification of product(s) of the component certificate (if applicable, the following test report(s): ). The modification of product(s) of the system certificate (EN54-13) (if applicable, the following test report(s): ).

For the systems EN54-13 please fill out the enclosed document CERT BOSEC P PROC 001 GENERAL RULES F WD 002 EN54-13 (not applicable for the certification «component»): - For the C.I.E.’S., indicate the following elements in the column «Supplementary information»: o List of options with requirements; o Indicate whether it is a configuration in «network» or «hierarchical »; o The accessories. - For the power supplies, indicate the following elements in the column «Supplementary information»: o Indicate whether it is an integrated, original or separate supply. - For all the components, indicate the following elements in the column «Supplementary information»: o Indicate whether there is an integrated short circuit isolator. - A product can only be considered as a variant of the basic product if it is mentioned on the same certificate CE/CPR.

For the following product(s):

BASIC TYPE (not applicable for the certification «system EN54-13»)

TYPE OF EQUIPMENT:

COMMERCIAL NAME:

IDENTIFICATION EQUIPMENT (IF DIFFERENT FROM NAME)

BRAND:

STANDARD:

NUMBER CERTIFICATE CE/CPR:

NUMBER DOP:

OTHER INFORMATION:

VARIANTS (not applicable for the certification EN54-13) (1 table per variant)

VARIANT 1

COMMERCIAL NAME:

BRAND: (IF DIFFERENT FROM BASIC TYPE) NUMBER CERTIFICATE CE/CPR: (IF DIFFERENT FROM BASIC TYPE) NUMBER DOP: (IF DIFFERENT FROM BASIC TYPE) Detailed list of differences compared to the basic type

VARIANT 2

COMMERCIAL NAME:

VARIANT 3

COMMERCIAL NAME:

VARIANT 4

COMMERCIAL NAME:

MANUFACTURER

NAME COMPANY:

STREET, NR:

POSTAL CODE, PLACE:

COUNTRY:

EMAIL:

NAME CONTACT:

PRODUCTION PLACE (if different from manufacturer)

NAME COMPANY:

STREET, NR:

POSTAL CODE, PLACE:

COUNTRY:

EMAIL:

NAME CONTACT:

STOCK PLACE

NAME COMPANY:

STREET, NR:

POSTAL CODE, PLACE:

COUNTRY:

EMAIL:

NAME CONTACT:

DISTRIBUTOR (if applicable)

NAME COMPANY:

STREET, NR:

POSTAL CODE, PLACE:

COUNTRY:

EMAIL:

NAME CONTACT:

The list of documents to be joined to this request, are enclosed: - Certificate ISO9001 from the manufacturer; - Test report(s) (for a new certification or for an extension of an existing certification); - For components submitted to the CPR, a copy of the certificate of consistency of performance CE-CPR (if not delivered by ANPI Division Certification) and the declaration of performance DoP from all the elements part of the request (component or system).

Done at on

ANNEXES List of documents to be joined to this request:

1 Test report(s) (for a new certification or an extension) Or Technical file in the case of a modification (if not given to the laboratories) 2 For the components submitted to the CPR, a copy of the certificate of consistency of performance CE-CPR (if not delivered by ANPI Division Certification) and the declaration of performance DoP 3 Copy of the certificate ISO 9001 (for which the scope covers the specific aspects of the production line of the product(s))