Appendix to Application for Conformity Assessment

Strojírenský zkušební ústav, s.p. (Engineering Test Institute, Public Enterprise), Czech Republic PED

Appendix to Application for Conformity Assessment pursuant to Government Regulation 219/2016 Coll.*) (hereinafter referred to as GR) (Directive 2014/68/EU*)) PRESSURE EQUIPMENT

Please submit with your Application the following: Technical documentation required for conformity assessment pursuant to Annex 3 to GR 219/2016 Coll., individual modules of conformity assessment. (Please mark with a cross the activities you wish to order, according to the pressure equipment category – Annex 2 to GR 219/2016 Coll.) 1. The Customer (the manufacturer or an authorized representative only) hereby orders from the Notified Body the following activities: 1.1 Internal production control plus supervised pressure equipment checks at random intervals pursuant to GR, Annex 3 (2) (Module A2) 1.2 EU-Type examination – production type pursuant to GR, Annex 3 (3.1) (Module B) 1.3 EU-Type examination – design type pursuant to GR, Annex 3 (3.2) (Module B)

1.4 Conformity to type based on internal production control plus supervised pressure equipment checks at random intervals pursuant to GR, Annex 3 (4) (Module C2) 1.5 Conformity to type based on quality assurance of the production process pursuant to GR, Annex 3 (5) (Module D) 1.6 Quality assurance of the production process pursuant to GR, Annex 3 (6) (Module D1)

1.7 Conformity to type based on pressure equipment quality assurance pursuant to GR, Annex 3 (7) (Module E)

1.8 Quality assurance of final pressure equipment inspection and testing pursuant to GR, Annex 3 (8) (Module E1)

1.9 Conformity to type based on pressure equipment verification pursuant to GR, Annex 3 (9) (Module F) 1.10 Conformity based on unit verification pursuant to GR, Annex 3 (10) (Module G)

1.11 Conformity based on full quality assurance pursuant to GR, Annex 3 (11) (Module H)

1.12 Conformity based on full quality assurance plus design examination and special surveillance of the final assessment pursuant to GR, Annex 3 (12) (Module H1) 1.13 European approval for materials pursuant to GR, Section 12

1.14 Issuance of: Certificate/s Language: Czech English German Other 1.15 Issuance of: Final (summary) report Language: Czech English German Other 1.16 Other (specify):

Appendix completed by:

Name and position of responsible person Date Signature, stamp

Should you need any help with completion of this form, please contact: Ing. Jiří Petr [email protected] (Brno) Ing. Miloš Váňa [email protected] (Jablonec nad Nisou) Ing. Aleš Onderek [email protected] (Brno) Ivana Moravcová [email protected] (Jablonec nad Nisou)

*) GR (Directive) as amended 1/1 PED v 01.00 Valid from 2016-07-19