Application for Safety Certification (Revision)

Job No. / Korea Testing Laboratory
Classi-
fication / Certification Application /  A: Normal  B:with test reports  C: with CB D: MOU/MRA  E: Other
Revision
Application /  F: Administrative revision  G: Add derivative model  H: Add or Change parts  I: Others
Factory Inspection /  Initial factory inspection / Country of Origin /  Domestic  Foreign (country: )
Manu-
facturer / Name / Business License
Address / Tel / Fax No.
President / Contact Person
(Name / Tel. )
Agent / Agent / Identification No.
Tel / FaxNo. / Contact Person
(Name / Tel. )
Address
With test reports / Testing body / Report Number
Factory / Address / Tel / Fax No.
Product / Name / Model
Rating / Trade mark
Applied standard / The old requirements IEC (Standard No : )
Derivative
Model
Revision / Certi. No.
Content of revision
Witness test /  Request the witness test at the factory /

Test repot

/  Request the test report
Sample verification /  Request the verification of testing sample to clear the customs.
Test sample disposal /  The applicant will come pick up The Certification Body can dispose after testing
 By delivery / Recipient address:
As I agree to follow the requirement of the Electrical Appliances Safety Control Law and the articles, which are indicated on the other side, I apply for the Safety Certification (or Revision) as the above, under paragraph 1, article 5 of the Law.
Date: (dd/mm/yy)
Applicant ( Signature )

The applicant shall read the "Articles of agreement " on the other side. Please sign by the president or a representative if it is agreed.

FP511-02-02

Submitting the Required Documents and Test Samples

  1. Product descriptions (or User's Manuals)
  2. List of critical components (manufacturer, model/type, specifications, and/or electric characteristic, etc.)
  3. List of materials for insulation (temperature and flammability grade)
  4. Circuit diagram
  5. Letter of authorization (in case of application by a local resident for foreign manufacturerfor legal representative)
  6. Two test samples (One sample when the EMC is not applicable) with additional parts for abnormal tests.
For component certification, quantities of testing samples from relevant standards are required.
  1. Marking label (2 ea.)
  2. Explanatory documents (in case of revision)

※Articles of agreement that requires the consent of the applicant
(Please make sure you understand the meaning of each word)
1.The obligations under the law shall be followed.
2.Korea Testing Laboratory (KTL) is not responsible for damages or disassemble of test samples if the causes are from testing.
3.KTL will dispose test samples with discretion if returning is not requested within six months after the issue of the certificate.
4.When members of KTL visit for initial or routine factory inspection, applicants shall corporate the members for their services
Routine factory inspection will be held once after the issue certificate.
Routine factory inspection date will be notified at least 3 days before the inspection.
5.KTL may refuse to issue or to return test samples if they are not paid for the certification.
Relevancy /

Information to Fill out The Application Form

Please mark  . Highlighted area can only be used for relevant cases.
Classifications in application: / * Please fill out the application form for each basic product.
* For first time application, please check the initial factory inspection.
(Here, initial factory inspection will only be held once per each product category.)
Manufacturer
(Agent) / *Manufacturershould be the one who actually produces the product in his production line.
*When a product is manufactured by several independent factories, the certification shall be issued for each factories although the product is the same model.
* Agent who is located in Korea and is authorized to apply for the certificate from a foreign manufacturer can submit the application as for a legal representative of the manufacturer.
* Please write the name and phone number of the person who is in charge of the registration.
Case B / When an applicant received a test report from a test body under recognition of KTL test report, please state the name of the testing body and reference number.
Factory / Factory is the place, which actually produces a product for the certification.
Product / If there are too many derivative models to be listed on the area, please indicate them on separate papers to attach them.
Revision / * Certification Number: Write the number for the previous certificate.
* Reasons for Revision: State the reasons to revise the application (if necessary, use separate papers).
Witness test / Manufacturers with product testing facilities can apply the witness test. In this case, travel & other expenses will be charged for the witness test at the factory.
Test Report / Test report will be issued only by your request, and additional fee will be charged for the report.
Sample verification / For a foreign applicant or its regal representative, please mark if the verification is required for customs clearance of the samples.
Handling of test samples after tests / When commercial delivery services are required for returning of samples, please write the name and address of the recipient, and delivery fee will be charged. For samples (3 million Won, 60Kg and over), which cannot be delivered by commercial delivery services, please contact KTL`.