INTERNATIONAL ELECTROTECHNICAL COMMISSION

QUALITY ASSESSMENT SYSTEM FOR ELECTRONIC COMPONENTS (IECQ)

DOCUMENT NUMBER: IECQ MC/130E/Q

DOCUMENT TYPE: IECQ Certification Body Scope Extension Application Form

VERSION: E

TITLE: IECQ Certification Body (IECQ CB) Application form and Capability Declaration for IECQ CBs seeking to apply for extension of scope

Document History

Date / Summary
2007 07 / Original Issue
2010 04 / Version A to update references to align with decisions from the 2010 IECQ US meetings
2011-05
2013-05
2015-02
2015-05 / Version B to update references and ensure consistency across documents
Version C to update references and align with IECQ 01 Ed.4.1
Version D updated to reflect change of office address
Version E to include the new Scheme for LED Lighting

IECQ Secretariat c/o IEC Sydney Office

Level 33 Australia Square, 264 George Street, Sydney NSW 2000 Australia

E-mail: | Fx: +61 2 4627 5285 | http://www.iecq.org


IECQ CB Application & Capability Declaration

This Declaration is applicable to IECQ CBs when seeking to extend their scope of

IECQ acceptance to other IECQ Schemes

This Declaration covers the following:

Name of Body:

______

Location(s) of Body:

______

Declaration covers extension of scope for the following IECQ Schemes / Programmes:

Please Mark with “X” / Schemes / Programmes
☐ / IECQ Approved Process Scheme
☐ / IECQ ESD
☐ / IECQ CAP – Counterfeit Avoidance Programme
☐ / IECQ Approved Component Products, Related Materials & Assemblies Scheme
☐ / IECQ AQP – Automotive Qualification Programme
☐ / IECQ LED – Scheme for LED Lighting
☐ / IECQ ECMP Scheme – Avionics Assessment Program
☐ / IECQ HSPM Scheme – Hazardous Substance Process Management
☐ / IECQ ITL Scheme – Independent Testing Laboratory

As the IECQ representative of the above organisation, I declare that:

a)  We have reviewed the rules, procedures and applicable IECQ documents, relevant to the IECQ Scheme activities identified above and understand the requirements

b)  The documents referred to in a) have now been integrated under our Document Control System in accordance with our quality management system

c)  We have the necessary facilities, competent Resources and procedures required to conduct the assessment

d)  In accordance with our Quality Management System we have appointed appropriately qualified and competent staff to conduct a thorough and full assessment to meet IECQ requirements.

e)  National accreditation covers these activities of the CB: YES / NO please indicate

Signature:

Date:

Name of representative:

Job Title:

When completed, this Declaration is to be submitted to the IECQ Secretariat via Email:

IECQ MC/130E/Q Ed. 2015-05 Page 1 of 2