/ APPLICATION / ФСУ-06.01/01EN
Issue:06
Date: 01.11.2015
Page1/3
Applicant’s outgoingNo.:
TINSA’s incoming No.:

FOR IMPLEMENTATION OF:

EC verification of conformity with Directive 2008/57/EC of the European Parliament and of the Council of 17 June 2008 on the interoperability of the rail system within the Community
Verification of conformity with the national notified technical or safety rules for railway subsystems
First verification / Re-registration
  1. INFORMATION FOR THE APPLICANT:

Name:
Address:
City, Country:
Phone: / Fax: / e-mail:
Manager of the Company: / Phone: / e-mail:
Contact person: / Phone: / e-mail:
Internet site:
UIC(if applicable):
  1. DESCRIPTION OF THE OBJECT/SUBSYSTEM/S FOR ASSESSMENT/VERIFICATION

Name of the object/subsystem/s:
  1. EC VERIFICATION: SCOPE – SELECTION OF SUBSYSTEM / STAGE/ MODULE

SUBSYSTEM / STAGE / PHASE / MODULE
Infrastructure / Design / SG SH1
Production / SG SH1
Final testing / SG SH1
Energy / Design / SG SH1
Production / SG SH1
Final testing / SG SH1
Control-Command and Signaling Track-side / Design / SB SG SH1
Production / SD SF SG SH1
Final testing / SD SF SG SH1
Control-Command and Signaling On-board / Design / SB SH1
Production / SD SF SH1
Final testing / SD SF SH1
  1. EC VERIFICATION OFASSPECT: PERSONS WITH REDUCED MOBILITY

SUBSYSTEM / STAGE / PHASE / MODULE
Infrastructure / Design / SG SH1
Production / SG SH1
Final testing / SG SH1
  1. EC VERIFICATION OFASSPECT: SAFETY IN RAILWAY TUNNELS

SUBSYSTEM / STAGE / PHASE / MODULE
Infrastructure / Design / SG SH1
Production / SG SH1
Final testing / SG SH1
Energy / Design / SG SH1
Production / SG SH1
Final testing / SG SH1
Control-Command and Signaling Track-side / Design / SG SH1
Production / SG SH1
Final testing / SG SH1
Control-Command and Signaling On-board / Design / SG SH1
Production / SG SH1
Final testing / SG SH1

IN CASE MODULE SD OR SH1 IS SELECTED IN TABLES 3, 4 AND 5, TABLE 14 MUST BE FILLED IN. OTHERWISE TABLE 14 SHALL NOT BE FILLED IN.

  1. VERIFICATIONOFCONFORMITY WITH THE NATIONAL NOTIFIED TECHNICAL AND SAFETY RULES – SELECTION OF SUBSYSTEM / STAGE

SUBSYSTEM / STAGE / PHASE
Infrastructure / Design Production Final testing
Energy / Design Production Final testing
CCS / Design Production Final testing
  1. ISSUE OF INTERMEDIATE STATEMENT OF VERIFICATION

Please specify detailed information for the selected subsystem and stage:
……….
  1. ASSESSMENT/VERIFICATION TO BE ACCOMPLISHED ACCORDING TO THE FOLLOWING DOCUMENTS:

Assessment criteria / Document Number
TSI for Infrastructure subsystem:
TSI for Energy subsystem:
TSI for Control, Command and Signaling subsystem:
TSI for Persons with Reduced Mobility:
TSIfor Safety in Railway Tunnels:
National rules:
Others: …………………………………………………………………………………

/The verification is performed by specified regulations in force at the date of application/

  1. ADDITIONAL DOCUMENTS FOR THE OBJECT

Copy of Derogation/s (if available). Commission decision/sAnnex No. ……
Copy of EC ISV declaration/s, Quality Management System Approval (if available). Declaration/Approval No. …..
Copy of the positive standpoint of the Railway Administration Executive Agency director in the terms of reference for the design of the project, according to Art. 44b of Ordinance 57. Annex No. ……
Copy of the positive standpoint of the Railway Administration Executive Agency director in theSafety Report, according to Art. 44b of Ordinance 57. Annex No. ……
Other documents:Annex No.
  1. ORGANIZATIONAL STRUCTURE OF THE APPLICANT

Information for the organization of the Applicant, including relations with larger organization (consortium, holding) (if applicable):
  1. INFORMATION FOR THE SUBSYSTEM

Subsystem / Location / Stage / Main contractor/manufacturer / Subcontractor
Infrastructure / Design
Production
Final testing
Energy / Design
Production
Final testing
Control-Command and Signaling / Design
Production
Final testing
  1. WORKING LANGUAGE OF THE EC VERIFICATION

English / Bulgarian / German / French / Other: ………………………………………………
  1. OTHER INFORMATION:

Other documents (at the discretion of the Applicant or requested by the Notified Body/Designated Body): AnnexNo. …

TABLE 14 MUST BE FILLED IN IF MODULE SH1 OR SD IS SELECTED IN TABLES 3, 4 AND 5.

  1. APPLICATION FOR QUALITY MANAGEMENT SYSTEM (QMS) ASSESSMENT

14.1.Subsystem
Infrastructure / Energy / Control-Command and Signaling
14.2.Annexes to the Application for QMS verification
Organizational structure of the project management
Names and addresses of all participated organizations
Quality Management System documents (related manuals, procedures, instructions, etc.)
Valid certificate for Quality Management System certification in accordance with ISO 9001 (if available)
  1. DECLARATION

WE DECLARE that we have not applied for EC verification and/or verification of conformity with the national notified technical and safety rules for this/ese subsystem/s before other Notified Body/s or Designated Body/s.
WE DECLARE that we will submit for the verification all needed technical and QMS documents, cited in DECISION 2010/713/EC and applicable for the selected module for verification.
Date: / Name:
Position:
City: / Signature: