Please Send a Copy of This Request To

/ Certification request product(s) in the domain of mobile objects /
CERT INCERT VT P PROC 001 GENERAL RULES F
WD 001 CUSTOMER REQUEST E V1

Please send a copy of this request to:

ANPI Division Certification –

Reserved for the administration

Applicant:

Already possesses a convention in the domainINCERT VTP:

The convention number is: V-B-

Informs about the modification of the data given in the tables underneath

Does not possess a convention

Name Company:
Street, nr:
Postal Code, Place:
Country:
Name Contact:
Function Contact:
Tel :
Fax :
Email:
VAT Nr:

The invoices for the certification costs have to addressed to (if different from above):

Name Company:
Street, nr:
Postal Code, Place:
Country:
Tel:
Fax:
Email:
VAT Nr:

106521/9©ANPI

/ Certification request product(s) in the domain of mobile objects /
CERT INCERT VT P PROC 001 GENERAL RULES F
WD 001 CUSTOMER REQUEST E V1

Appoints the following person to represent him/her for all questions with relation to the study of this request:

Name Contact:
Function contact:
Company (if different)
Postal Code, Place:
Country:
Tel:
Fax:
Email:

Declares that the above-mentioned company (tick the appropriate box(es)):

has the industrial ownership (patent-rights)
has an exploitation licence
restricts itself to put the product on the market
manufactures the product by licensed companies, submitted to his control and mentioned by name in the list in annex.
entrust the placement to licensed companies, submitted to his control and mentioned by name in the list in annex.

Makes the commitment

-to complete his file, if necessary, on the request of the Certification body, by giving all the information and testing justification pieces in order to allow the technical evaluation of the fabrication as well as the implementation of the system/components characteristics and properties.;

-to respect the certification rules INCERT and the prevailing conditions of the certification. He also declares to accept the certification costs.

Authorizes the laboratories, that carried out the tests, to report all complementary information that could be asked within the framework of the file examination.

Request

AINCERT certificatebased on the following test report(s):
The renewal of the certificate .
The extension of the certificate .
The modification of product(s) of the certificate -- (if applicable, the following test report(s):).

For the following product(s):

BASIC TYPE

Type of Equipment:
Commercial Name:
Identification Equipment
(if different from name)
Brand:
MOUNTING TYPE SYSTEM / Factory installed
After-market
Note:If a dealer – concessionaire intervenes on a factory mounted system, the system becomes an after-market system
Programmable product / YES NO
Place label:
Private car
For bicycles and tricycles (with the exception of mopeds) / IM (always with passive arming)
AL1: neitherpassive arming notrearming
AL2: with passive arming and rearming
If IM coupled to a certified alarm system (AL):
IA1IM + AL1
IA2IM + AL2
AT1with only restart prevention
AT2 AT1 + speed limitation (only private car)
TT0 system for which the alarm can only be generated at the initiative of the owner of the vehicle (no automatic alarm) and without restart prevention
TT1without driver recognition and without restart prevention
TT2with driver recognition and without restart prevention
TT3without driver recognition and with restart prevention
TT4with driver recognition and with restart prevention
TT5a tracking and tracing system class TT4 coupled with an after-theft system class AT2 (only private car)
Company cars / IM1with passive arming and attack resistance during 5 minutes
IM2with passive arming and attack resistance during 5 minutes
AL1without passive arming and without rearming
AL2with passive arming and with rearming
If IM coupled to a certified alarm system (AL):
IA1 IM1+ AL1
IA2IM1 + AL2
IA3IM2 + AL1
IA4IM2 + AL2
AT1with only restart prevention
TT0system for which the alarm can only be generated at the initiative of the owner of the vehicle (no automatic alarm) and without restart prevention
TT1without driver recognition and without restart prevention
TT2 with driver recognition and without restart prevention
TT3 without driver recognition and with restart prevention
TT4 with driver recognition and with restart prevention
Mobile object (trailers, semi-trailers, container, …) / AL1without passive arming and without rearming
AL2 without passive arming and with rearming
TT0 system with tracking and tracing function on demand
TT1system with fraud detection and tracking and tracing system
TT2function TT1 + driver recognition and tracking and tracing started after movement detection
TT3 function TT1 + geofencing
TT4 functions TT1 + TT2 + TT3
Other information:

VARIANTS(1 tableau par variant)

VARIANT 1

Commercial Name:
Identification Equipment
(if different from name)
Brand:
(if different from basic type)
Place label:
(if different from basic type)
Detailed list of differences compared to the basic type

VARIANT 2

VARIANT 3

VARIANT 4

MANUFACTURER

Name company:
Street, nr:
Postal Code, Place:
Country:
Tel:
Fax:
Email:
Name Contact:

PRODUCTION PLACE (if different from manufacturer)

Name company:
Street, nr:
Postal Code, Place:
Country:
Tel:
Fax:
Email:
Name Contact:

STOCK PLACE

Name company:
Street, nr:
Postal Code, Place:
Country:
Tel:
Fax:
Email:
Name Contact:

DISTRIBUTOR (if applicable)

Name company:
Street, nr:
Postal Code, Place:
Country:
Tel:
Fax:
Email:
Name Contact:

The list of documents to be joined to this request is enclosed

Done aton

ANNEXES

List of documents to be joint to this request:

1. / Test report(s) (for a new certification or an extension)
Or
Technical file in the case of a modification (if not given to the laboratories)
2. / The proof of registration in the Belgian Register of Commerce or equivalent in another country of the European Union
3. / Declaration of the manufacturer of the product group for which he/she requests the INCERT certification (cf. doc. CEB Nr 005 art 7.3.2)
4. / If the applicant is certified EN ISO 9001, a copy of the certificate.
5.
6.
7.
8.
9.
10.