(JAB RFL01E REV.20)

to: President,

Japan Accreditation Board

Date: DD / MM / YYYY

Application for Accreditation

(forTesting/Calibration Laboratory)

Weapply for accreditation as a testing/calibrationlaboratory according to

JIS Q17025:2005（ISO/IEC 17025:2005)with theinformation below:

1. Type of application

□ Initial assessment

□ Re­assessment (Accreditation No. )

□ Extension of the scope of accreditation (Accreditation No. )

2．Name/Address/of the applicant laboratory: as stated onAttachment

Note) Please be advised that Company's name and URL (domain) shall not include "ISO" or

"IEC".

3. Applied scope of accreditation:as stated onAttachment

4. Commercial status: as stated onAttachment

Representative of the legal entity of the applicant body:

Signature/Name:
Title:
Name of the legal entity :
Registered address:

(JAB RFL01E REV.20)

Accreditation No.

Attachment 1

■Commercial status :

□Commercial service only

□Commercial service is also available

□Commercial service is not available

■Contact person :

Name :
Division and title:
Address:
TEL : / ( ) - / FAX : / ( ) -
e-mail :
URL :

Do you wish to be listed on the JAB website of the URL address above?

Yes ( ) No ( )

【Please refer NOTES below on entry to Attachment 2】

1.On Initial application, box of Accreditation No. will be left blank.

2.Items inside thick frames are reflected AS IS on Accreditation Certificate, so please fill information carefully.

3.Entry for Premises on which testing or calibrating activities are performed

1)If some of the premises are located at different address but not far from one another, you may select one of them to represent others. However any premise more than 10km from others should be listed separately in the list. i.e. Each name and address of such premise should be unique.

2)If one premise contains satellite premise within 10km distance, and address of which is different, such satellite premise should be listed separately.

3)Please fill the name of premises as well as its scope of accreditation, one premise by one separately on the Attachment 2. Copy and Paste will be helpful for adding information of multiple premises.

4)Different type of Attachment 2 is attached for each of the testing or calibrating categories. Please select appropriate list according to the applying scope.

4.Entry for Premises on which other than testing or calibrating are performed

1)All premises should be listed in Attachment 2, unless its address is the same as that of others.

2)Two types of Attachment 2 is attached for testing and calibration. Please select appropriate one.

5.On Re-assessment or Extension of Scope application, use the copy of the original Attachment and edit information as necessary with MS-Word’s Revision History Function, which is to make sure changed information can be clearly recognized.

6.In case of Notification of Change includes description change on the Accreditation Certificate, use the copy of the original Attachment and edit information as necessary with MS-Word’s Revision History Function, which is to make sure changed information can be clearly recognize.
Please submit the revised Attachment with the Notification Change Cover sheet.

7.Please submit Attachment 1 and 2 ( MS-Word version ) by E-Mail or through Internet Storage Service.

8.If accreditation scope includes “opinion and interpretation”, either calibration procedure or test method standard should clearly state that such method includes opinion and interpretation. Please contact JAB secretariat in such cases.

9.On applying for Renewal assessment or Extending assessment, add / delete / modify current accreditation scope with history of editing.MS word’s revision view functions will be preferably used.

10.When submitting Notification of Changeregarding to small changes of accreditation scope, please use attachment 2 to clearly show the changes. In this case MS-word’s revision view functions will be preferably used.

11.When submitting attachment 2, original MS-Word file is required. Such file may be submitted via email or internet storage service.

12.Units and Symbols should be described according to International System of Units (SI). JAB-NL512 would be helpful to refer.

(JAB RFL01E REV.20)

Accreditation No.

Attachment 2（Calibration Laboratory）

- 1/ 2-

Type of Laboratory / CalibrationLaboratory
Name of Laboratory
Address

1) Premises on which calibration activities are performed

Name of Premises
Address of
Premises / Postal Code
Address
Calibration service at permanent
facilities or on site calibration
service / □Calibration service at permanent facilities
□On site calibration service
Address of premises
(If physical address is different
from that of abovementioned
premises, and if physical
distance is less than 10 km)

Scope of Accreditation

CODE OF
CLASSIFICATION,
QUANTITY
MEASURAND /
CALIBRATION ITEM / RANGE OF
CALIBRATION / EXPANDED
UNCERTAINTY
(APPROXIMATELY 95 % COVERAGE PROBABILITY,
k=2) / CALIBRATION PROCEDURE,
REMARKS
(NOTE)

2) Premises on which key activities except calibration are performed

Name of Premises
Address of
Premises / Postal code
Address
Key activities performed in
the premises
(check the checkbox) / □Policy formulation
□Process and/or procedure development □Contract review
□Plan calibrations □Review on the results of calibrations
□Approval and decision on the results of calibrations

(JAB RFL01E REV.20)

Accreditation No.

Attachment 2（Testing Laboratory）

- 1/ 5-

Type of Laboratory / Testing Laboratory
Name of Laboratory
Address

1) Premises on which testing activities are performed

Name of Premises
Address of
Premises / Postal code
Address
Testing service at
permanent facilities or
on site testing service / □Testing service at permanent facilities
□On site testing service
Address of premises
(If physical address is different
from that of abovementioned
premises, and if physical
distance is less than 10 km)

Scope of Accreditation

FIELD / M21 Electrical Testing
CODE OF CLASSIFICATION,
NAME / TEST METHOD STANDARD
(NOTE)

Scope of Accreditation

FIELD / M24
Radioactivity/ Radiation Testing / *1 CIT: Classification of Item to be Tested
*2 TCT: Technical Classification of Test
CODE OF CIT*1
NAME OF CIT
MATERIALS OR
PRODUCTS TESTED / PROPERTIES
MEASURED / TEST METHOD STANDARD /
STANDARD OPERATING PROCEDURE
(NOTE)

Scope of Accreditation

FIELD / M25 Mechanical Testing / *1 CIT: Classification of Item to be Tested
*2 TCT: Technical Classification of Test
CODE OF CIT*1
NAME OF CIT
CODE & NAME OF TCT*2 / TEST METHOD STANDARD OR
STANDARD OPERATING PROCEDURE (SECTION NO. LIMITED OR EXCLUDED) / TEST CONDITION etc.
(NOTE)

Scope of Accreditation

FIELD / M26 ChemicalTesting / *1 CIT: Classification of Item to be Tested
*2 TCT: Technical Classification of Test
CODE OF CIT*1
NAME OF CIT
CODE & NAME OF TCT*2 / PROPERTIES
MEASURED / TEST METHOD STANDARD /
STANDARD OPERATING PROCEDURE
(Note)

Scope of Accreditation

FIELD / M27 Foodand Drug Testing / *1 CIT: Classification of Item to be Tested
*2 TCT: Technical Classification of Test
CODE OF CIT*1
MATERIALS OR
PRODUCTS TESTED
CODE & NAME OF TCT*2 / PROPERTIES
MEASURED / TEST METHOD STANDARD /
STANDARD OPERATING PROCEDURE
(NOTE)

Scope of Accreditation

FIELD / M28
Testing for Construction Materials / *1 CIT: Classification of Item to be Tested
*2 TCT: Technical Classification of Test
CODE OF CIT*1
NAME OF CIT
CODE & CLASS OF
TCT*2 / TEST METHOD STANDARD /
STANDARD OPERATING PROCEDURE
(NOTE)

Scope of Accreditation

FIELD / M29
Test Regarding the Fire Service Law
CODE OF CLASSIFICATION,CLASS / TEST METHOD STANDARD AND DETAILS
(NOTE)

Scope of Accreditation

FIELD / M30 Ship test
CODE AND CLASS OF CLASSIFICATION, / TEST METHOD STANDARD AND DETAILS
(NOTE)

Scope of Accreditation

FIELD / M31
Testing for Industrial Safety Devices
CODE AND CLASS OF CLASSIFICATION, / TEST METHOD STANDARD AND DETAILS
(NOTE)

Scope of Accreditation

FIELD / M32
Biological Sciences Testing / *1 CIT: Classification of Item to be Tested
*2 TCT: Technical Classification of Test
CODE OF CIT*1
NAME OF CIT
CODE & NAME OF TCT*2 / PROPERTIES
MEASURED / TEST METHOD STANDARD /
STANDARD OPERATING PROCEDURE
(Note)
Type of Laboratory / Testing Laboratory
Name of Laboratory
Address

2) Premises on which key activities except testing are performed

Name of Premises
Address of
Premises / Postal code
Address
Key activities performed in the
premise
(check the checkbox) / □Policy formulation
□Process and/or procedure development □Contract review
□Plan tests □Review on the results of tests
□Approval and decision on the results of tests