IECEx and ANZExCertification Schemes
Certification of explosion-protected electrical equipment
REQUEST FOR QUOTE AND APPLICATION FOR CERTIFICATIONCertificate of Conformity / IECEx
IECEx Unit Type Test* / ANZEx
ANZEx Restricted Type Test*
New application
Change to existing Certificate / State existing certificate number:
PART A - Applicant information
Name of applicant:
ABN, if applicable:
Street address: / City:
State/Province:
Postal code: / Country:
Postal address:
Contact person: / Position:
Telephone: / Email: / Facsimile:
Name of certificate holder:
Name & address of manufacturing location (if different to above):
If manufacturing location is different to above, please complete below: N/A:
Indicate relationships/products/subassemblies of each site.
Who is responsible for thelabelling / certification marking / dispatch of the product?
Who keeps records, e.g. serial numbers/batch release records and how long are these records retained?
How is the dispatch controlled?
*Contact MSTC regarding details of IECEx Unit Type Test or ANZEx Restricted Type Test Certificates
PART B - Product information and Certificates of Conformity
1. Certificates of conformity
Identify any certificate of conformity already held for the product or product series. (If first certificate required, go to 2.) (If space insufficient, please attach details)
2. Description of equipment
This will become the title of your Test Report and Certificate of Conformity
(Please include details of any modification for supplementary certification).
3. Type of protection / IP Rating
d / e / ia Ib ic / [ia] [Ib] / ma mb mc / s / mD iaD ibD / IP / As tested
4. Hazardous area/EPL levels
Ma
(Group I) / Mb
(Group I) / Ga
Zone 0
(Group II) / Gb
Zone 1
(Group II) / Gc
Zone 2
(Group II) / Da
Zone 20
(Group III) / Db
Zone 21
(Group III) / Dc
Zone 22
(Group III)
5. Equipment group
I / IIA / IIB / IIC / IIIA / IIIB / IIIC
6. Temperature rating
Group I / Group II / Group III / As tested
150°C / T1 / T2 / T3 / T °C
450°C / T4 / T5 / T6
7. Ambient/service temperature range
MINIMUM / MAXIMUM / (DEFAULT) -20°c/+40°C / AS TESTED
8. Standard(s)
9. List of drawings (please attached extra pages if space is not adequate)
10. ANZEx-ATL commissioned to carry out test (ANZEx scheme only) other than MSTC.
PART C - Quality Management System information
*Not required in the case of IECEx Unit Type Test and ANZEx Restricted Type Test Certifications
Does the manufacturer have a Quality Management System complying with ISO9001:2008?
Yes / No
If yes, state the name of the third-party certification body and enclose a copy of the certificate showing scope of certification.
Original manufacturer:
Alternative manufacturer:
Does the manufacturer have a documented Product Quality Plan relevant to the submitted product?
Yes / No
If yes, please submit with this application.
Original manufacturer:
Alternative manufacturer(s):
Please do not fill the following until you have accepted the MSTC quote and MSTC terms and conditions
PART D – Undertaking
I/we confirm that I/we have read, understood, agree and undertake to abide by the rules and procedures of the ANZExScheme, as outlined in publication MP87.1, the IECEx Scheme as outlined in IECEx 02 and MSTC terms and conditions specified in the General Terms & Conditions attached, further we confirm that the product now submitted for certification was designed to comply with the requirements of the standards outlined in Part B of this application, and that no copyright and intellectual property related to the product has been infringed by this application.
Signed by authorized person for and on behalf of applicant*
Name (in BLOCK LETTERS):
Title or position of signatory:
Sample testing
I hereby request MSTC to examine and test the equipment described in the schedule below for compliance with the specified IEC standard(s) and nominated national differences.
Where the application includes reference to options, variations, or more than one model or type, I request MSTC to examine and report on the effect of such options, variations or different models with respect to the requirements of the standard or standards.
I accept that damage may occur to the equipment as a result of the testing carried out.
Invoicing
I agree to pay all costs, as agreed by written quotation, incurred in carrying out the above work and will make payment in the timeframe stipulated by MSTC, for such costs in accordance with MSTC’s commercial forms.
Please raise an invoice for fee and quote this purchase order number:
Address for forwarding invoice:
Accounts payable contact Name:
Phone: / Fax:
Sample Return
I hereby accept all freight and handling charges are the responsibility of the customer. Contact details must be provided for liaison on sample return.
Contact Person: / Phone: / Fax:
I have provided details of our nominated courier and account number for MSTC to use.
Nominated courier: / Account No.:
Address for sample return:
I agree that if all the above information is not provided, and I fail to collect the sample, MSTC will arrange sample return (at their discretion), and all relevant charges will be the customers responsibility.
Certificate to be sent to: / Name:
Address:
Email:
Signature of authorized person*:
Name in BLOCK LETTERS:
Title or position of signatory:
(in the case of a Company, Firm, or Partnership)
Date:
*Person signing on behalf of the applicant shall be an authorized company representative. If application is lodged by a person not directly employed by the intended certificate holder, then a letter from the intended certificate holder shall be attached.
ABN 72 189 919 072 / Mine Safety Technology Centre
Trade & Investment NSW
8 Hartley Drive Thornton NSW 2322 Australia
PO Box 343 Hunter Region Mail Centre NSW 2310 Australia
Tel: 02 49244009 Fax 02 49244080 Website:www.trade.nsw.gov.au
Email: /
Accreditation by the Joint Accreditation System of Australia and New Zealand
Acc No. xxxxxxxxx
www.jas-anz.com.au\register
Appendix A
MSTC General Terms and Conditions
MSTC reserves the right to change prices, revoke terms and discontinue services except when otherwise indicated in these terms. If and when, it becomes necessary to revoke or modify any provisions of these terms or discontinue services to the client, MSTC will take whatever action it deems, in its own judgement, fair and appropriate.
Clients must ensure that all cooperation required of them, of their agents, of their employees or of other third parties in connection with the services must comply with all legal requirements and industry safety Regulations and Standards.
The following standard terms and conditions of contract apply to our quotation and any contract which ensues from it.
1. Quotations or estimates
Acceptance of the MSTC quotation or the estimate in writing or by way of purchase order within a period of 30 days (unless otherwise agreed) will lock the quotation or estimate, otherwise the cost may rise. The quote or estimate does not include the cost of any unforeseen additional work required by MSTC due to failures, modification of design or specification or requests by the client.
The quote or estimate is based on the estimated assessment and testing time required to finish the job and the applicable certificate fee. The quote or estimate includes the expected date of completion, which MSTC will endeavour to work towards without guaranteeing a specific date.
Additional charges not included in the quote
Work performed at the request of the client outside normal working hours in order to speed up the outcome of the required service may be subject to surcharges to recover additional costs borne by MSTC.
Travel fees, incurred expenses relative to the service, other material and additional costs are charged separately, unless such costs are included in the quotation.
2. Scope
The scope of work is defined in the quotation or estimate which in turn is dictated by the applicable equipment standards and certification standards and rules.
The services rendered by MSTC will be deemed accepted by the client unless a written notice describing the deficiency is received by MSTC within five business days from the delivery date.
3. Customer supplied sample items
All documentation, samples and materials necessary and reasonably required for the performance of the services must be made available to MSTC.
The Client agrees that product samples submitted for testing and/or certification may be destroyed or damaged during the testing or the process of certification. Unless otherwise instructed by the client or required by the applicable certification standards, MSTC will retain all product samples, damaged or otherwise, for a minimum period of 4 weeks after the conclusion of the testing and/or certification process, unless MSTC receives a request, within the period that the client wishes to have the samples returned. After such time, MSTC is free to dispose of the product samples in any way it deems appropriate. All costs associated with the return of product samples and any client supplied items or the safe and proper disposal will be borne solely by the client.
4. Terms of payment
Payments for services are required within 30 day of the invoice date. Progressive (quarterly) invoicing may be required depending on quoted amount and/or, in the case of completion of the job taking in excess of three months, will be preceded by a job progress report.
MSTC reserves the right to suspend the job in progress, withhold the issue of a test report or certificate or suspend issued certificate if the terms of payment are breached.
5. Terminations
A contract for service may be terminated by either party giving seven days written notice of termination to the other party. MSTC is entitled to invoice the client for all costs incurred by MSTC for services provided up to and including the date of termination.
6. Confidentiality
MSTC will hold information, documentation, products and material relating to all work conducted for the client in confidence and will issue the results to the client only through their nominated contact(s). The client agrees not to use MSTC or its employees in its publicity or advertising unless prior approval has been granted in writing by the MSTC Manager.
The information collected by MSTC will only be used by MSTC and will not be provided to a third party.
7. Applicable Law
Any contract emanating from our quotation shall be governed and constructed with reference to the current law in force in the State of New South Wales, and both parties shall submit to the jurisdiction of the courts and tribunals of New South Wales.
8. Indemnity
The client shall indemnify MSTC, its officers, its employees and its agents against any losses, claims, damages, liabilities, penalties, actions, proceedings or judgments of any kind (including the cost of defending or settling any claims, demands or actions) brought against MSTC or the Department of Trade and Investment, Regional Infrastructure and Services for any death or injury to a person or loss or damage to property resulting from MSTC assessed, tested or certified or from any act or omission by its officers, employees, agents or contractors or any claim that the use of any of the materials or products provided to MSTC (and any publications, reproduction or communication thereof) breaches any intellectual property or moral rights of any third party.
All assessment, testing and certification of equipment or product is carried out according to the relevant Australian, international standards and certification scheme rules and MSTC assessment. Testing and certification is based on information, documentation and samples provided by the client.
9. Copyrights
The copyrights to all documents, including joint copyrights in certifications, expert opinions, reports, test results, raw data, calculations, descriptions, etc., which are produced by MSTC in the course of providing service to the client remain the sole property MSTC. All such documents, certifications, expert opinions, reports, test results, raw data, calculations, descriptions, etc., may be used by the client only for their intended purpose.
Certificates can be used at the client discretion but the certificate may only be reproduced in full.
10. Client undertaking
The Client must ensure that certified products are manufactured in conformity with all applicable standards requirements, information, documentation and samples provided by the client in his application in order to achieve certification.
Compliance with this requirement may be established by MSTC, its agents, representative or another suitable certifying body through auditing of the client’s manufacturing facilities. The auditing team shall be granted free access to any facilities of the client that is engaged in the manufacture or distribution of the products including to all relevant production processes, as is required to establish that the client complies with the applicable requirements.
The client must ensure that certification marks may only be used in strict compliance with the certified marking document and only on fully compliant and certified equipment. Clients shall have procedures in place to prevent misuse of the certification marks. Failure of complying with this term is likely to result in the cancellation of the certificate without notice.
The IECEx Mark may be used only by manufacturers who have been issued with the Mark Licence in accordance with the IECEx 04 rules and the IECEx 01B Guidance Document. The IECEx LOGO is to be used only when in accordance with the IECEx 01B Guidance Document.
The client shall inform MSTC of any changes to the design, material (including components) or manufacturing process or location of MSTC certified equipment in order for MSTC to evaluate if a supplementary assessment or audit is required. Until such time MSTC has informed the client that the changes are of no consequence to the certification or a supplementary certificate is issued, any produced equipment subject to the change shall not be considered certified and shall not bear the certificate mark.
The client must ensure that certification is used only to indicate that the certified equipment is conforming to standards, that claims regarding certification are only made in respect of the scope for which the certification is granted and that no certificate or report nor any part thereof is used in a misleading manner and reference to its certification in communication media such as documents, brochures or advertising, complies with MSTC requirements.