Strojírenský zkušební ústav, s.p.
Odštěpný závod 2 SZÚ s.p. Jablonec nad Nisou, Tovární 5, 466 21 Jablonec nad Nisou, ČR / HRA

Appendix to Application for Conformity Assessment

pursuant to Government Regulation 176/2008 Coll.*) (hereinafter referred to as GR) (Directive 2006/42/EC*))
MACHINERY

Please submit with your Application the following:

Technical documentation required for conformity assessment pursuant to Annex 7 to GR 176/2008 Coll., and for electrical parts pursuant to Annex 3 (2) to GR 118/2016 Coll.

(Please mark with a cross the activities you wish to order)

1. The Customer (the manufacturer or an authorized representative only) hereby orders from the Notified Body the following activities:
1.1 / EC type-examination for a product specified in Annex 4 to GR176/2008 Coll., pursuant to Annex 9, and subsequent issuance of EC type-examination certificate (GR176/2008 Coll., Section 5 (3) (b); Section 5 (4) (a))
1.2 / Full quality assurance pursuant to Annex 10 (2, 3) toGR176/2008 Coll. – the quality system assessment and performance of surveillance with subsequent issuance of reports (GR176/2008 Coll., Section 5 (3) (c); Section 5 (4) (b))
2. The Customer hereby orders from the Engineering Test Institute, Public Enterprise, the following activities (Beyond the scope of the Notified Body's activities):
2.1 / Assessment of conformity of incomplete machinery (GR176/2008 Coll., Section 6)
2.2 / Assessment of conformity with essential requirements pursuant to Annex 1 to GR 176/2008 Coll., for internal production control, concluded with issuance of final report
2.3 / Assessment of conformity with essential requirements pursuant to Annex 1 to GR 176/2008 Coll., for internal production control, and subsequent issuance of certificate
2.4 / Assessment of conformity of electrical parts with essential requirements of GR 118/2016 Coll. (2014/35/EU)
2.5 / Assessment of conformity of electrical parts with essential requirements of GR 117/2016 Coll. (2014/30/EU)
2.6 / Verification of machinery conformity with requirements of the standard
2.7 / Issuance of: / Certificate/s
Language: / Czech / English / German / Other
2.8 / Issuance of: / Final (summary) report
Language: / Czech / English / German / Other
2.9 / 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:

Bc. Petr Kuběna (Brno) Ing. Aleš Mach (Jablonec nad Nisou)

Ing. Jiří Petr (Brno) Ivana Moravcová (Jablonec nad Nisou)

*) NV (směrnice) vplatném znění / 2/1 / HRA vXX.00
Platí od 2013-MM-DD