IMPORTANT: the Quality and Completeness of the Documentation Submitted by the Applicant

/ Request for Certificate of Conformity*
*Request for Technical Inspection Report
*Request for Certificate of Inspection
RFI –
For Intertek Use Only

IMPORTANT: The quality and completeness of the documentation submitted by the Applicant directly influences the time and cost of processing the certification request. This form must be completed in FULL. Applications will not be processed without all of the information completed. If more space is needed, additional sheets may be attached.

TYPE OF APPLICATION
/ / VALID FROM / VALID TO
NOTE:*This option is only VALID for regular exporters having frequent shipments of the same products.
This RFC can be used for multiple shipments of the same products within the validity period indicated. Validity period shall not exceed one year in all cases.
SERVICES REQUESTED
APPLICANT TYPE
EXPORTER (APPLICANT) DETAILS / IMPORTER DETAILS
COMPANY NAME
COMPANY ADDRESS
CONTACT PERSON
E-MAIL ADDRESS
TELEPHONE NO.
FAX NO.
TRADE LICENCE NO
For KSA Shipments only
TRADE LICENCE
EXPIRY DATE
CUSTOMS DEALER NO.
For EGYPT Shipments Only
For NIGERIA IMPORTERS Only / BA NO. / RC/BN NO. / TIN
SHIPMENT DETAILS (SHIPMENT LOCATION WHERE GOODS ARE AVAILABLE FOR INSPECTION IF DIFFERENT FROM EXPORTER’S DETAIS)
SITE NAME
SITE ADDRESS
CONTACT PERSON
TELEPHONE NO.
E-MAIL ADDRESS
FAX NO.
SHIPMENT REFERENCE, IF AVAILABLE
PROFORMA INVOICE NO. / PROFORMA INV. DATE
IDF NO.
For KENYA Shipments Only / BL OR AWB NO.
L/C NO.
For ALGERIA Shipments Only / II NO.
For NIGER Shipments Only
PAD NO.
For TANZANIA Shipments Only / OTHERS, (Please Specify)
UCR NO. For GABON / GHANA/ KENYA Shipments Only
SHIPMENT DELIVERY
PORT OF LOADING / PORT OF DISCHARGE
VESSEL NAME / COUNTRY OF SUPPLY
GOODS AVAILABILITY DATE / EXPECTED SHIPMENT DATE / GROSS
CONSIGNMENT WEIGHT
GOODS CONDITION / / / DELIVERY / /
MODE OF TRANSPORT / / / / /
MODE OF SHIPMENT / CONTAINERS / / / / /
QUANTITY
DOCUMENTS ATTACHED TO THIS APPLICATION
PAYMENT DETAILS RESPONSIBLE PARTY WHO WILL BE PAYING FOR THE SERVICES APPLICANT WILL RECEIVE
PAYMENT-IN-CHARGE / / / /
COMPANY NAME
COMPANY ADDRESS
CONTACT PERSON
TELEPHONE NO.
E-MAIL ADDRESS
FAX NO.
PAYMENT TYPE / / / INTERTEK CREDIT REFERENCE NO.
ADDRESS WHERE INVOICE TO BE SENT / CURRENCY TO BE USED FOR INVOICES
REMARKS AND COMMENTS(PLEASE PROVIDE, IF ANY)
In general, all imported goods subject to specific programme requirements may be subjected or randomly selected for inspection and testing for SAFETY, QUALITY and trade compliance purposes at the Customs territory. Intertek performs the evaluation of conformity based on a random sampling of your products and on testing of limited parameters through a risk assessment approach. Thus, by signing this request form, you take your own responsibility and ACKNOWLEDGE that you are aware of the Customs legislative and regulatory requirements governing the import of your products AND COMMIT TO COMPLY WITH THOSE REQUIEREMENTS. IN AGREEING TO PROVIDE THE SERVICES PURSUANT TO THIS AGREEMENT, INTERTEK DOES NOT ABRIDGE, ABROGATE OR UNDERTAKE TO DISCHARGE ANY OF YOUR DUTY OR OBLIGATION TO THE RELEVANT AUTHORITIES WITH REGARD TO THE QUALITY AND SAFETY OF YOUR PRODUCTS.
DECLARATION
I/WE DECLARE THAT ALL PRODUCTS LISTED ON THIS APPLICATION ARE NOT AFFECTED BY ANY PRODUCT RECALLS NOR THESE ARE SUBSTANDARD OR COUNTERFEIT, TO THE BEST OF OUR KNOWLEDGE. I/WE ALSO DECLARE UNDER OUR OWN RESPONSIBILITY THAT THE PRODUCTS LISTED IN THIS APPLICATION TO WHICH THIS DECLARATION OF CONFORMITY RELATES, SATISFY THE REQUIREMENTS OF THE STANDARDS AND OTHER NORMATIVE DOCUMENTS REGULATIONSAPPLICABLE TO THIS TYPE OF PRODUCTS FOR EXPORT. I/WE CONSENT TO INTERTEK’S GENERALTERMS AND CONDITIONS FOR SERVICESAND THE REQUIREMENTS STATED HEREIN, WHICH FORM AN INTEGRAL PART OF THIS APPLICATION. I/WE ALSO ACKNOWLEDGE ANDAGREE THAT INTERTEKMAYSHARE ANY OF THE DATA, RESULTS AND DOCUMENTATION GATHERED AND GENERATED DURING THE PERFORMANCE OF THESERVICES TO THE EXTENT REQUESTED BY THE RELEVENT AUTHORITIES TO VERIFY THE CONFORMITY OF THE PRODUCTS.I/WE ALSO DECLARE THAT AT THE TIME OF THE SUBMISSION OF THIS RFC,THE SHIPMENT IS STILL IN THE COUNTRY OF SUPPLY AND IS ACCESSIBLE FOR INSPECTION, IF NEEDED.
NAME / SIGNATURE
POSITION / DATE

***********************************************

SUBMISSION OF THIS APPLICATION CONFIRMS CONSENT TO THE TERMS SET OUT BELOW

This Request for Certification (RFC) and any services performed by Intertek (including any Certificate or report issued in response to this application)are subject to Intertek's General Terms and Conditions of Services, which are expressly incorporated by reference and a copy of which is available from our nearest Intertek Office or at our website: Terms and Condition - Government Services.

Unless otherwise explicitly agreed between the parties in writing, this RFC and Intertek General Terms and Conditions of Services represent the entire agreement and understand between the parties in relation to its subject matter.

The Exporter acknowledges that, in submitting the RFC, it has not relied on any oral or written representation, warranty, or other assurance (except as provided for or referred to in this RFC) and waives all rights and remedies which might otherwise be available to it in respect thereof, provided always, that nothing in this clause limits or excludes any liability for fraud.

Intertek represents and warrants that any Certificate or report issued in response to this RFC is issued with due care, in accordance with the industry practices and within the limits of the mandate received from the relevant government to operate the Conformity Assessment Programme.

Inspection Auditors and/or Observers from the Intertek Office are to be allowed access to the Exporter’s inspection site without prior notice in order to verifythat a recent inspection performed by the Exporter has been correctly conducted. The Auditors and/or Observers are authorized by the Intertek Officeto amend or overturn the recent inspection outcome if the result of the audit supports this action. The audit will be conducted in a manner that does not unduly interfere with the export of the products nor jeopardize the exporter’s legitimate interests.

Exporter acknowledges that Approved Laboratories are acting as independent and importation laboratories. In the event of conflict between the Exporter and an Approved Laboratory relating to the testing of the products, the dispute shall be resolved by the two parties, without involvement or responsibility on the part of the Intertek Office or Programme Management (PM).

In the event of conflict between the Exporter and any of the Intertek Officesrelating to the inspection, evaluation, licensing, registration or certification of the regulated products, the Exporter shall be entitled to submit a complaint to the Intertek Office. If no agreement can be reached, the dispute should be escalated to the Programme Management within two (2) weeks from the date of submittal of the complaint to the Intertek Office. Documents supporting the Exporter’s point of view shall be attached to the appeal. Programme Management undertakes to investigate the complaint in accordance with Intertek’s internal complaints procedure, and report its findings to the Exporter within one (1) month from the date of receipt.

The Exporter agrees to cooperate in good faith with Intertek for the investigation of any complaints received in relation to the exported products and Services.

The Exporter is responsible for informing Intertek in advance of any applicable import/export restrictions that may apply, including instances where products, information or technology may be exported to a country that is restricted or banned from such export.

The Exporter commits to fulfill the certification requirements set out in this RFC, in the Exporter and Importer guidelines or as requested in writing by Intertek from time to time (including but not limited to Proforma Invoice, Packing List, Bill of Lading, Test Reports, Letter of Credit, Photos of the Products, Registration, Licence, QMS certificates, etc.) including implementation of appropriate changes as and when advised by Intertek.

The Exporter commits to use the Conformity Certificate solely for the purpose for which it has been issued for and must refrain from any form of misuse or make any statement that may cause disrepute to Intertek. The Conformity Certificate issued is only for the shipment verified by Intertek and must not be used in any form (including but not limited to communication media and marketing documents) to indicate otherwise. The Exporter must not use the Intertek logo in any documents, brochures, etc. without prior consent from Intertek.

If the Exporter provides copies of the Conformity Certificate to a third partypursuant to the purpose for which the certificate was provided, the document shall be reproduced initsentirety.

The service undertaken by Intertek does not absolve the Importer andExporterfrom their contractual obligations to each other, or from compliance with any other import or export regulations and with any applicable law.

Unless otherwise explicitly agreed between the parties in writing, the above conditions shall be governed by English law and any dispute arising out of this RFC to which these conditions apply shall be subject to the jurisdiction of the English Courts.

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Thank you for taking the time in filling out this form. We appreciate your business!

GTS-PM-CAP-FRM-RFC-27
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/ Request for Certificate of Conformity*
*Request for Technical Inspection Report
*Request for Certificate of Inspection

NOTE:Please complete the below required details if this information has NOT been made available in the submitted invoice/shipment documents or has NOT been provided separately in editable electronicformat(e.g. word, excel, rich text format document). Should you require additional space, please attach EXTRA SHEETS using the same template as below.

PRODUCT DETAILS(EXCEPT AUTOMOTIVE VEHICLES)
PRODUCT CATEGORY / QUANTITY / PACKING / PRODUCT DESCRIPTION / HS CODE / BRAND / COUNTRY OF ORIGIN / MANUFACTURER’S
NAME AND ADDRESS / STANDARD REFERENCE / REGISTRATION / LICENCE
(SfR/SoR/TER/ PC)
(IF AVAILABLE)
ADDITIONAL INFORMATION PROVIDED ON SEPARATE SHEETS / / NO. OF ADDITIONAL SHEETS /
acronyms USED / AWB – Airway Bill / BA – Banker’s Acceptance / BL – Bill of Lading / CNY - China Yuan Renminbi / EUR – Euro / FCL – Full Container Load / IDF - Import Declaration Form
HSCode- Harmonized Commodity Description and Coding System / II- (Intention d’Importation) / INR – Indian Rupee / JPY – Japan Yen / l/c - Letter Of Credit / LCL - Less than Container Load
PAD – Pre-Arrival Declaration / PC – Product Certificate / QMS - Quality Management Systems / RC/BN – Registration/ Business Number / SfR / SoR – Statement for Registration / TER - Technical Evaluation Report
TIN – Tax Identification Number / UCR – Unique Consignment Reference / USD – US Dollars / vin – VehicleIdentification Number

PRODUCT DETAILS(FOR AUTOMOTIVE VEHICLES)
MAKE/BRAND
(E.G. TOYOTA) / VEHICLE TYPE
(E.G. PASSENGER CAR) / VEHICLE MODEL
(E.G. COROLLA 1.8GLI) / MODEL YEAR
(E.G. 2010) / COUNTRY
OF ORIGIN / VIN
ADDITIONAL INFORMATION PROVIDED ON SEPARATE SHEETS / / NO. OF ADDITIONAL SHEETS /
GTS-PM-CAP-FRM-RFC-27
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