Pressure Equipment Directive PED 97/23/EG

/ To be filled in by LR-Nederland
File no: …………………………
Order no: …………………………

Application Form

Pressure Equipment

Pressure Equipment Directive PED 97/23/EG

Not intended for application of assemblies, pressure systems and inspection for putting into service; see applicable application forms.

This request form is not a contract.

Applicant (legal manufacturer, as stated in the PED)

Undersigned: / Contact person:
Address: / City:
Country: / VAT number:

The manufacturer requests a conformity assessment of the equipment according to the module (or combination of modules):

A1Monitoring of final assessment

BIssue of a Certificate of EC-type examination

B1Issue of a Certificate of EC-design examination

C1Monitoring of final assessment in relation to conformity to type

FProduct verification, based on EC-type / EC-design examination

GEC unit verification

H1Issue of a Certificate of EC-design examination and special
surveillance of the final assessment

ad B1Issue of a addition to a Certificate of EC-design examination

ad BIssue of a addition to a Certificate of EC- type examination

ad H1Issue of a addition to a Certificate of EC-design examination

In case of an addition: it concerns the original file no.:

______

The manufacturer declares that a similar request for EC-design or type-examination, according to modules
B, B1, G or H1, has not been lodged with any other notified body.

Place: / Date: / Signature:

Subcontractor

If the above mentioned manufacturer is not the fabricator of the pressure equipment, the equipment is fabricated by:

Name: / Address:
City: / Country:

End user (if known)

Name: / Address:
City: / Country:

Type of pressure equipment

(PED, art. 3):(par.1.1) Vessel(par. 1.3) Piping
(par. 1.2) Boiler (TS>110°C)(par. 1.4) Safety accessory
(par. 1.4) Pressure accessory

Data of the pressure equipment

Description / type:
Production: / Single item Serial production
Number of the same type/design or related to one ‘family’:
Fabrication / serial number(s):
Reference: (projectnr. / PO nr. / Etc)
Pressure equipmentdata
Item number / reference of the equipment
Name of the chambers
CapacityL
(vessel)
Heated surfacem2
Nominal diameter (piping)DN
Inside diameter mm1)
Max /min. allowable pressure PSbar2)
Max./min. allowable temperature TS °C2)
Fluid
(full name and/or composition)
Phase of the fluid at the maximum allowable temperature TS: (Gas (G), liquefied gas (G), gas dissolved under pressure (G), vapour (G), liquid (L))
Atmospheric boiling point of the fluid(s)C
Vapour pressure at the maximum allowable temperaturebar
Fluid group according PED, art.9 / 1 2 / 1 2 / 1 2 / 1 2
Applied table according PED, art.3, par.1 / PED, app. II
Category of chamber
Equipment category according PED, appendix II
(art. 9 par. 3)
Remarks
Design basis / Harmonized standard
EN 13445
Dutch Rules for Pressure vessels (RToD) / ASME VIII, Div. 1
PD 5500
Other:
Danger class/construction category/joint efficiency according to chosen design basis

1)If DN is not known inside diameter shall be stated in mm.

2)In case of a combination of pressure and temperature, please fill in one column for each combination. Clarification can de added under remarks.

Documents to be submitted with the application
Modules / Ref. to
Remarkss
A1 / B* / B1* / C1 / F / G / H1*
General / (8) / (8) / (8)
Application form / (1) / (1) / (1) / (1) / (1) / (1) / (1)
Result of the hazard analyses / (4) / (4) / (4) / (4)
Design and fabrication drawings and other relevant technical documentation / (2) / (1) / (1) / (2) / (2) / (1) / (1)
Particular Material Appraisal / (4) / (4) / (4) / (4)
List of applied harmonised standards
Design calculations / results of examination related to the design / (1) / (1) / (1) / (1)
Copy or number of the Certificate of EC-type-examination module B / (1)
Copy or number of the Certificate of EC-type examination B or EC-design examination, module B1 / (1)
Copy of the certificate of the QA system module H / (3)
Qualifications / approvals of the methods for permanent joints / (3) / (3) / (3)
Qualifications / approvals of personnel for permanent joints / (3) / (7) / (3) / (3)
Qualifications / approvals for personnel for NDT / (3) / (7) / (3) / (3)
Production scheme / (5) / (5) / (5)
Concept test and inspection plan / (3) / (3) / (3) / (3) / (3) / (3)

Required information

Required information, included with this application (checkmark to be filled in by the applicant)

Clarification of the table “Documents to be submitted with the application

*In case of an application for an addition to an EC design or type approval, reference can be made to information supplied with a previous application, as far as this is still valid.

(1)If not included, the application can not be processed.

(2)Information for quotation purposes.

(3)Not necessary to send in with this application. Can be examined during the inspection phase.

(4)Design appraisal can be started, but not finalised without this information. EC-Certificate can only be issued after this information has been made available.

(5)Required for planning visits.

(6)Information not mandatory to include in the application, but recommended in order to avoid complication during the inspection phase.

(7)If not made available a note on the Certificate of EC-design examination will be placed, stating that this certificate is only valid, after the missing information being approved by a notified body.

(8)When applying for an addition to a Declaration of EC-design examination, the original Declaration and possible addition shall be included with the application.

Remarks

Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss, damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively on the terms and conditions set out in that contract. /

FORM-S-101 (2013-05)

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Appendix to:
Application Form
Pressure Equipment
Pressure Equipment Directive PED 97/23/EG

This appendix containsuseful customerinformation for the inspection phase.

In particular it describes the documents needed to complete inspection requirements.

Please note that the documents mentioned will need to be available during (final) inspection.

A copy of said documents will have to be available for our surveyor.

This page should not be submitted with the application form

Documents to be submitted to Lloyd’s Registersurveyor
Modules
A1 / B / B1 / C1 / F / G / H1
Complete Design Appraisal Document (DAD) incl. Visit Report. Preferebly the original document.
DAD will be returned to you as certificate attachment
Signed and completed Test and Inspection Plan
List of welders- and welding procedure qualifications / * / * / *
Listof materials / * / * / *
(List and/or overview of ) NDT / * / * / *
(List of) NDT personel Qualifications. / * / * / *
EC Type-, or Design examination Certificate
(concept) Declaration of Conformity
(concept) Operating Instructions

* Possible, depending on the nature & extend of surveillance / monitoring. (Documents should be present,

copy can be requested at the surveyors discretion)

FORM-S-101 (2013-05)

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