(T2, A1, FB7-0, REV16), Status 19.04.2017
DVS ZERT GmbH
Aachener Straße 172
40223 Düsseldorf
Customer no.: / Click here to enter text.(will be filled in by DVS ZERT GmbH)
☐ Request for offer (Please scope of application.)
The application, which is legally not binding, serves to the preparation of an offer and is free of charge.
☐ Order for certification (Please tick scope of application.)
The legally binding order serves to prepare a cost estimate as far as no quotation has been given so far.
The General Terms and Conditions are accepted.
Applicant/Customer/Client
(Organisation/Manufacturer) / Click here to enter text.Street:
ZIP/Town:
Contact person: / Click here to enter text.
Phone no.: / Click here to enter text.
E-Mail: / Click here to enter text.
Internet address: / Click here to enter text.
VAT ID: / Click here to enter text.
Main products: / Click here to enter text.
Sectors: / ☐ Metal production, Metal processing, Manufacturing of metallic products
☐ Mechanical engineering
☐ Manufacturing of office machines, data processing devices and -installations, Electrical engineering, Precision mechanics, Optics
☐ Vehicle construction (automobile, rail vehicles, motorcycles)
☐ Construction industry
☐ non-bearing parts
☐ bearing, mainly static loads
☐ bearing, dynamically loaded parts
☐ Research and Development
☐ Architectural and Engineering offices
☐ Rendering of services for companies
☐ Education and training
☐ Initial certification / Preferred date: Click here to enter text.
☐ Re-certification / Preferred date: Click here to enter text.
☐ Monitoring / Preferred date: Click here to enter text.
☐ Preliminary audit / Preferred date: Click here to enter text.
Scope of application (please tick where applicable)
☐ EN 1090-1 in connection with EN 1090-2Please fill in annex 1 / ☐ EXC 1, / ☐ EXC 2, / ☐ EXC 3, / ☐ EXC 4
☐ EN 1090-1 in connection with EN 1090-3
Please fill in annex 1 / ☐ EXC 1, / ☐ EXC 2, / ☐ EXC 3, / ☐ EXC 4
☐ Welding certificate pursuant to / ☐ EN 1090-2 / ☐ EN 1090-3
☐ Further product standards acc. to BauPVO (please state) / Click here to enter text.
☐ EN 15085-2 ☐ including DIN 27201-6
Please fill in annex 2 / ☐ CL 1 / ☐ CL 2 / ☐ CL 3 / ☐ CL 4
☐ ISO 3834
Please fill in annex 3 / ☐ ISO 3834-2 / ☐ ISO 3834-3 / ☐ ISO 3834-4
☐ ISO 9001:2015
Please fill in annex 4
☐ Scope I, SCC*
Please fill in annex 5 / ☐ Scope I, SCC** / ☐ Scope I, SCCp
☐ Scope II, SCP
Please fill in annex 5
* restricted certificate, ** non-restricted certificate
This certificate shall be issued in the following languages:
☐ GER / ☐ EN / ☐ FR / ☐ other: Click here to enter text.
The organisation/manufacturer agrees to the electronic collection of the disclosed data and the inclusion of them into a register after issuing of the certificate. For certificates pursuant to EN ISO 3834 / EN 1090 / EN 15085, this also applies to personal data of welding coordinators (name, first name, qualification, date of birth). The consent of the relevant persons is deemed to be given.
Click here to enter text.Place and date / Legally binding signature
Stamp
General questions on the application/order
Which are the available qualification certificates of the company?
Issued by:☐ WPK certification EN 1090-1 / Click here to enter text.
☐ Welding certificate EN 1090-2/-3 / Click here to enter text.
☐ Certificate EN 15085-2 / Click here to enter text.
☐ Certificate ISO 3834 / Click here to enter text.
☐ Certificate ISO 9001 / Click here to enter text.
☐ Certificate SCC / Click here to enter text.
☐ Others: / Click here to enter text. / Click here to enter text.
Were you consulted by third parties during the implementation of the company’s management system?
☐ Yes / ☐ NoIf „yes“, please state the organisation you were consulted by: / Click here to enter text.
Personnel
Note: The number of staff is related to employees who are covered by the regulations of the management system. It also applies to employees who are engaged according to the personnel leasing law (AÜG). Part-time employed members of staff and AÜG staff (temporarily leased) are to be evaluated according to their actual working time (e.g. two employees working half time like one full time employee). It does not apply to employees with factory contracts.
Number of staff in total: / Click here to enter text.Among them employed in:
Administration: / Click here to enter text.
Research/development: / Click here to enter text.
Construction: / Click here to enter text.
Manufacture: / Click here to enter text.
Assembly: / Click here to enter text.
Quality assurance: / Click here to enter text.
Temporarily leased staff (AÜG) / Click here to enter text.
Does the organisation have subsidiaries/ branches/production sites?
(Only state if these shall be included in the certification procedure.)
Please state the company names and addresses of the subsidiaries/branches/productions sites (as an annex, if necessary).
(Not applicable for organisations without branches.)
Please include a list of the staff and assign it to the branches/production sites (as an annex, if necessary). (Not applicable for organisations without branches.)
Click here to enter text.☐ Annex / Click here to enter text.
Do you work shift time in your company and in the subsidiaries/production sites/operation sites?
☐ No
☐ Yes. Please state the number of common shifts according to the branches/production sites/operating sites.
Which language shall be used during the audit?
☐ German / ☐ Other, please state which: / Click here to enter text.FB7-0REV16_Order_Certifcation_General-Information.docx Page 3 of 3 pages