Name of firm/corporation

Address

Address of factory(ies) if different from above

Contact person

Position

Description of product including model or type

A copy of the product specification is to be attached. * Details of approvals granted by other authorities

I hereby undertake:

• To conform to the regulations of the use of the "Tested Product" Certificate and the requirements of the basic scheme of the Inspection and Test;

• To pay all costs connected with assessment testing and administration in the pre-certificate stage, irrespective of the eventual granting of a certificate.

Note: (1) This application is valid for a maximum period of three months from the date of receipt;
(2) In unavoidable circumstances testing and inspections may be subcontracted.

Enclosed cheque /bank slip

Amount

Date

Signature

*Product specification may be an existing published national, Regional International or Company standards.