Changes to Certification Application Form

CHANGES TO CERTIFICATION APPLICATION FORM

Please complete all relevant fields and email, together with any supporting information to:

Please only submit this document asa word file so that information can be easily extracted.

Applicant:
Certificate number:
Applicant Address (please use currently registered address)
Contact details (name):
Telephone:
Email:
Declaration by applicant
In making this application we confirm that:

The approved Quality Management System continues to be maintained;
That the application is supplied with evidence of the Type Examination Certificate’s holder permission to verify the instrument;
Confirmation from theType Examination Certificate’sholder that technical documentation (2014/31/EU, Annex II, 1.3 (c) and 2014/32/EU Article 18), technical support and replacement parts are available.

Signatory name:
Electronic signature:
Date :
Date from which the additions are requested to be effective:

Please indicate what changes are required

Type of change required / YES / NO / Cost
Change of name/address / *YES/NO
If yes please provide new address here: / £95
Other non-technical change / *YES/NO / £95
Addition of EU Type Examination Certificates to:
NAWI Directive 2014/31/EU, Annex II, Module D Certificate, Schedule of Certification. / *YES/NO / £190
MID Directive 2014/32/EU, Annex II, Modules D & E Certificate, Schedule of Certification. / *YES/NO / £190
Weights & Measures Act 1985 section 11a Certificate, Type Approval Schedule. / *YES/NO / £190

*Delete as applicable

ACB Extension to scope Rev 3- June 2016

Please provide details of the EUType Examination Certificates to be added in the following format:

EXAMPLE:

Certificate No:(Certificate Number)
Name of Notified Body: (Issuing authority of the Type Examination)
Certificate issued to: (Name of the manufacturer certificate issued to)
In respect of:(Accuracy classes and Type / Model numbers)
Configurations: (Details of any specific configurations)
Restrictions:(Details of any specific restrictions)

TO BE ADDED TO NMO CERTIFICATE NUMBER:

(Enter certificate number here )

Type ExaminationCertificate No:
Name of Notified Body:
Certificate issued to:
In respect of:
Configurations:
Restrictions:
Are there any related changes to the quality manual / verification processes and documents as a result of this addition?
(If yes, please email the relevant documents to us for review)

Add additional boxes for each additional EU Type Examination Certificates as required

ACB Extension to scope Rev 3- June 2016