Doc. Ref: EWC-QU-FT-69

(Issue 4 – 02/06/2017)

Page 1 of 5

Notified Body No: 1121

PRODUCT CERTIFICATION MARINE EQUIPMENT DIRECTIVE

– REQUEST FORM

From here on in, references to Exova (UK) Limited trading as Warrington Certification will be shown as Warrington Certification.

We request Warrington Certification to carry out the conformity assessment for the under mentioned equipment for Product Certification

1.  SPECIFY THE APPLICATION TYPE

New application: ¨ / Amendment to existing application: ¨
If yes, please specify the ID or job number:

2.  APPLICANTS NAMES & NORMAL BUSINESS ADDRESS

Name: / NOTES
Enter office name & address for routine correspondence and nominate a contact familiar with your request for EC Product Certification
Address:
Postcode:
Nominated Contact:
Tel No: / Fax No:
E-mail address:

3.  PRODUCER’S NAME & NORMAL BUSINESS ADDRESS

Name: / NOTES
Enter details ONLY if they are different to those entered in section 1.
Address:
Postcode:
Nominated Contact:
Tel No: / Fax No:
E-mail address:

4.  EUROPEAN BUSINESS ADDRESS

Name: /

NOTES

Enter details of the agent or person with responsibility for the product in Europe unless this is also the address of the Applicant
Address:
Postcode:
Nominated Contact:
Tel No: / Fax No:
E-mail address:

5.  PLACE OF PRODUCTION

Name: To be determined – facilities will be “modular” and portable / NOTES
Enter details of the production facility where the product is manufactured. If more than 1 factory is involved please provide additional addresses.
The nominated contact is required to facilitate making arrangements to visit the facility.
Address:
Postcode:
Nominated Contact:
Tel No: / Fax No:
E-mail address:

6.  TYPE OF REQUEST

New EC Certificate £ Renewal of EC Certificate £
Extension of EC Certificate £ / NOTES
Please tick P the appropriate box
If an extension, please state previous Certificate Number:

7.  PRODUCT ACCOUNTABILITY (Only complete this section if the details in sections 1 & 2 are different)

What is your relationship with the producer? / NOTES
Please provide details in this section if you completed both section 1 and section 2 of the form.
Where there is a bi-lateral agreement, e.g. licensee, include a statement from the producer confirming the agreement.
Include changes to the label or type designation, in addition to details of any design changes.
This also refers to:
- incoming goods from producer
- ensuring conformity during production. e.g. ISO 9000 series, own quality system etc.
Do you alter the product before marketing? Yes £ No £
If ‘Yes’ please specify:
What procedures are followed to verify conformity of the product to design specifications?

8.  DESCRIPTION OF PRODUCT

a)  Abbreviated version: / NOTES
This description will form the basis of that which will appear on your Certificate.
The detailed description should precisely identify the equipment (product) and will be used as the basis for the schedule to the certificate.
b) Detailed description

9.  NORMAL TYPE DESIGNATION

Reference No: / NOTES
See Annex A. 1/3 of the Marine Equipment Directive
Is this a general code for a range of products? Yes £ No £
If ‘Yes’, state whether the entire range OR which individual items from the range are to be approved: Individual products. One is currently available. Another will be available in 2 months.
Is this a range of products? Please provide details of the range.
Colour?
Thickness?
Density?
Other?

10.  DESIGN PERFORMANCE STANDARDS, CODES AND RULES

Please state the standards that the product is to be certified as complying with:
i.e.
IMO Resolution MSC 307 (88) Annex 1 Part 1 (non combustibility test) £
IMO Resolution MSC 307 (88) Annex 1 Part 2 (Smoke and toxicity test) £
IMO Resolution MSC 307 (88) Annex 1 Part 3 (fire resistance of A, B and C class divisions) £
IMO Resolution MSC 307 (88) Annex 1 Part 4 (Test for fire door control systems) £
IMO Resolution MSC 307 (88) Annex 1 Part 5 (Surface Flammability test) £
IMO Resolution MSC 307 (88) Annex 1 Part 7 (vertically supported textile and films test) £
IMO Resolution MSC 307 (88) Annex 1 Part 8 (upholstered furniture test) £
IMO Resolution MSC 307 (88) Annex 1 Part 9 (Bedding components test) £
IMO Resolution MSC 307 (88) Annex 1 Part 10 (fire-restricting materials for high speed craft test) £
IMO Resolution MSC 307 (88) Annex 1 Part 11 (fire-resisting divisions of high speed craft test) £
Not Known £ / Notes
This may include the producer’s own specifications i.e. FPC tests, provided a copy is submitted with this request. This must include however, the required IMO Test Specification as given in the Fire Test Procedures Code.

11.  DOCUMENT CHECK LIST

A general description of the product. / £ / NOTES
Please tick ‘P’ to indicate that the required information has been provided.
Provide one set of relevant & comprehensive documentation, which will be retained by Warrington Certification.
Confirm that the appropriate information has been provided.
Design drawings, catalogue, data sheet sufficient to fully define the product (as appropriate) / £
Schemes of components, sub assemblies etc. (as appropriate) / £
Functional description. / £
Full Description. / £

As appropriate – please include if necessary:-

Technical construction file. / £ / NOTES
Please tick ‘P’ to indicate which appropriate documentation has also been provided.
Existing test reports. / £
Relevant existing certificates. / £
Description of changes since previous Approval (see section 4) / £
Statement from producer (see section 5) / £

12.  DECLARATION

We declare that the information given in this form is accurate and complete and that a Conformity Assessment is request for Marine Equipment detailed herein.
We confirm that the same application has not been lodged with any other notified body.
We agree to give Warrington Certification or their representative every facility and necessary access to carry out their duties and agree to pay the fees and expenses incurred for any services provided resulting from this request.
We are aware that it is our responsibility to send the supporting final test reports through to Warrington Certification and understand that certification will not be granted without the correct documentation being received.
In the event of the Conformity assessment not being completed we understand that charges will be made at a rate pro-rata for services rendered.

This request is made upon the following terms:

Product Certification is based on the understanding of compliance with the manufacturer’s recommendations and instructions and any relevant requirements of the Directive(s).
Warrington Certification will execute the Product Certification in accordance with the procedure set out in Warrington Certification Guidance Notes for AoC for Marine Equipment Directive.
Product Certification certifies that a representative sample of the product(s) referred to herein has/have found to meet the applicable criteria for the Directive(s) specified herein. It does not mean or imply approval for any other use, nor for any products(s) designed and manufactured otherwise than in strict conformity with the said representative sample. It is understood that Warrington Certification will not conduct specific checks relating to computer software or hardware.
Warrington Certification reserves the right to cancel or withdraw Product Certification.
In providing services, information or advice, neither Warrington Certification nor any of its officers, employees or agents warrants the accuracy of any information or advice supplied. Except as set out herein, neither Warrington Certification nor any of its officers, employees or agents (on behalf of Warrington Certification has agreed this clause) shall be liable for any loss, damage or expense whatever sustained by any person due to any act, omission or error of whatsoever nature and howsoever cause of Warrington Certification its officers, employees or agents or due to any inaccuracy of whatsoever nature, howsoever caused in any information or advise given in any way whatsoever b or on behalf of Warrington Certification, even if held to amount to a breach of warranty. Nevertheless, if any person , who is party to the agreement pursuant to which Warrington Certification provides any service, uses Warrington Certification services or relies on any information or advise given by or on behalf of Warrington Certification and suffers loss, damage or expense thereby which is probed to have been due to any negligent act, omission or error, Warrington Certification, its officers, employees or agents or any negligent inaccuracy of information or advise given by or on behalf of Warrington Certification, then Warrington Certification will pay compensation to such person for his proved loss, up to, but not exceeding the amount of the fee (if any) charged by Warrington Certification for that particular service, information or advice. Any dispute concerning the provision of Warrington Certification services under this contract is subject to the exclusive jurisdiction of the English Courts and will be governed by English Law.
Warrington Certification its officers, employees or agents (on behalf of whom this notice is given) shall be under no liability or responsibility negligence or otherwise howsoever to any person who is not a party to the agreement with Warrington Certification in respect of any information or advice implied or expressly given by Warrington Certification or in respect of any act, omission or inaccuracy by Warringtonfire.
Signature: / Date:
Name (in BLOCK CAPITALS): / Our reference:
Position in Company:

Exova (UK) Limited trading as Warrington Certification

Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom. Co. Reg. No. SC070429