FORM FOR THE APPLICATION TO ISSUE
A EUROPEAN TECHNICAL ASSESSMENT
UNDER ARTICLE 26 OF REGULATION (EU) No. 305/2011
1. The application is made to:
Kiwa Nederland B.V., Sir Winston Churchillaan 273, Postbus 70, 2280 AB Rijswijk, Netherlands
2. Applicant:
a) Manufacturer[1](Name and address):
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b) Or a an authorized representative (based in the European Union):
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according to the attached written mandate, dated: Click here to enter text.
3. ETA holder (if different from the applicant):
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4. Type of construction product:
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5. Trade name(s) of the product, which shall be included in the European Technical Assessment:
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6. Description of the construction product, the intended use or the intended uses and the essential characteristics of the product:
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7. Assessment of essential characteristics of the product with methods and criteria used in other harmonized technical specification(s)[2]
☐ /- The product is covered by EAD No: Click here to enter text.
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- The product is covered by ETAG[3] No: Click here to enter text.
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- The product is partially covered by an harmonized standard (hEN) No:Click here to enter text.
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- The product is partially covered by EAD No:Click here to enter text.
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- For the construction product there are no applicable harmonised methods and criteria for assessing the performances of the product under an hEN, an EAD or an ETAG.
8. Documents requiredfor application
In cases 1 and 2 of Section 7.:
Additional technical documentation shall be presented to allow a judgement that the said EAD or the said ETAG can be applied in full.
In cases 3, 4 and 5 of Section 7.:
For a complete application a technical file shall by all means be submitted by the manufacturer 2.
☐The technical file, dated Click here to enter text., is enclosed.
☐The technical file is expected to be submitted to Kiwa by Click here to enter text.
9. Manufacturing plant(s)[4]:
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10. Declaration of the applicant
I hereby declare that2
☐I have not filed an application for a European Technical Assessment for the construction product with any other Technical Assessment Body;
☐I have filed an application with
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(Name of the Technical Assessment Body)
That request was rejected/withdrawn, because Click here to enter text.
Furthermore, I declare that
- I agree that the European Organisation for Technical Assessment (EOTA), the designated TAB’s and the European Commission shall be informed about the content of this application;
- I will bear the costs of issuing the European Technical Assessment according to the contract with Kiwa;
- I will support the assessment procedure as required and agreed in a subsequent contract;
- I will ensure that the manufacturing plant(s) can be visited at any time during the operating times by representatives of Kiwa;
- I further declare that I am prepared to inform Kiwa without delay of the first making available of the product on the market with CE marking.
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(Place and date)
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(Stamp/Signature)
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Form sheet application ETA according to CPR version 29-10-2013
[1]According to Article 2(19) of the Regulation the 'manufacturer' means any natural or legal person who manufactures a construction product or who has such a product designed or manufactured, and markets that product under his name or trademark. An Assessment is generally issued for one applicant each.
[2]Mark with a cross where applicable
[3]Used as an EAD according to Art. 66 (3) of the Regulation (EU) No. 305/2011)
[4]Where the construction product is to be produced