Revision No: / 2.0
Verification of EN 15804+A1 EPD / Date: / 24 March 2017
Page: / Page 2 of 4 - 2 -Page 2 of 4
Please complete all aspects of this form and return it with any additional information requested to:
The Scheme Manager, BRE Global EN 15804 Verified EPD Scheme, BRE Global Limited, Garston, Watford, WD25 9XX, or by email to
EPD Owner Details
Registered NameTrading Name (if different)
Trading Address
Contact Name & Position
Telephone
Fax
Company Registration Number
Uncontrolled copy if printed.
Valid on day of printing only. / © BRE Global Ltd 2017
/ VERIFICATION APPLICATION FORM / Doc No: / BF1324
Revision No: / 2.0
Verification of EN 15804+A1 EPD / Date: / 24 March 2017
Page: / Page 2 of 4 - 2 -Page 2 of 4
Scope of Verification Application
Type of product(s) covered by EPDNumber of EPD
Confirmation that PCR used is to EN 15804+A1 /
In the table below, please complete a separate row for each EPD to be verified (Row 1 has been completed as an example; please insert additional rows if required):
EPD / EPD Type† / Modules / Single product or range of products / Product Name / Manufacturer-specific or generic / Number manufacturing sites / Individual LCA Report or combined LCA report /1 / Cradle-to-gate with options / A1 to A3, C4 and D / Single product / XYZ concrete tile / Manufacturer-specific / One / Individual LCA report
†There are three types of EPD: 1) cradle-to-gate; 2) cradle-to-gate with options; 3) cradle-to-grave
Company DeclarationAuthorised representative of Company:
I hereby confirm on behalf of…………………………….. (the Company), that the information contained in this document is correct, any changes in circumstances will be notified to BRE Global in writing.
Name: Position:
Signature*: Date
*We accept electronic signatures.
For additional guidance on the Verification Application Form, please contact: The Scheme Manager, BRE Global EN 15804 EPD Verification Scheme,
Uncontrolled copy if printed.Valid on day of printing only. / © BRE Global Ltd 2017