Some Or All Details in Sections 1, 4, 5 & 6 Appear on Certificates And/Or Publicly on The

/ Application for Electrical Product Certification
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PRODUCT DESCRIPTION:
(Add model details in Section 4 below or on the attached spreadsheet if >5 models)
FOR NEW CERTIFICATION (select the certificate type and certification standard)
see "Note on the Electrical Equipment Safety System (EESS)" for details of the different certificate types.
Certificate of Approval / Certificate of Conformity / Certificate of Suitability
Certification Standard:
FOR CHANGES TO EXISTING CERTIFICATES / Existing Certificate Number
Modification/change of particulars (e.g. address or model change) (complete 1,2,3,4,5,6,8) / Renewal (complete 1,2,3,4,6,8)
1 APPLICANT / CERTIFICATE HOLDER DETAILS / ABN or NZ IRD No. (Required only if Applicant is also Responsible Supplier)
Company
Address
Contact / Position
Telephone / (+ ) ( ) / Mobile / (+ )( )
E-mail / Facsimile / (+ )( )
Applicant to complete declaration in all cases.
I hereby make application to UL International NZ Ltd for electrical product certification services as described in this application and declare that:
-All statements and information provided in this application are true to the best of my knowledge.
-I have read and understand the attached TERMS AND CONDITIONS OF CERTIFICATION, agree to comply with them and agree to supply any information needed for the evaluation of product(s) to be certified.
-Products submitted for certification are representative of all production samples to be covered by any issued certificate, each of which will be clearly and indelibly marked with any required marking.
-Any change(s) to the name and/or address of the certificate holder, or to the certified product(s) will be notified to UL International New Zealand Ltd in accordance with the attached TERMS AND CONDITIONS OF CERTIFICATION.
-I am an employee of the Applicant and am authorised by the Applicant to make this declaration

Some or all details in sections 1, 4, 5 & 6 appear on certificates and/or publicly on the EESS national database. The operator of the database has committed not to publish Certificate holder address, phone number or email address or the name and address of the Manufacturer.

/ Application for Electrical Product Certification
39-IC-F0025Issue 9.0Page 1 of 1
Authorised signature / Date
Name and Position
(if different from above)

/ Application for Electrical Product Certification
39-IC-F0025Issue 9.0Page 1 of 1
ONCE SIGNED, PLEASE RETURN ALL PAGES OF THIS FORM TO UL AT
2 AGENT DETAILS (if applicable) / Certificate to be sent to agent
Company
Address
Contact / Position
Telephone / (+ )( ) / Mobile / (+ )( )
E-mail / Facsimile / (+ )( )
3 MANUFACTURER DETAILS (the entity who owns oroperates the physical location where the end product is produced/assembled. The address is the physical location where the production/assembly occurs).
Manufacturer 1
Same as Applicant, OR
Company
Address
Contact / Position
Manufacturer 2
Company
Address
Contact / Position
Manufacturer 3
Company
Address
Contact / Position
Manufacturer 4
Company
Address
Contact / Position
ONCE SIGNED, PLEASE RETURN ALL PAGES OF THIS FORM TO UL AT

/ Application for Electrical Product Certification
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4 PRODUCT DETAILS
These details appear on the certificate / Manufacturers’ Model No. on test report(s) (Needed for cross reference)
Applicant’s Model No. to appear on certificate / Brand(s)/ Trademarks / Distinguishing differences between models (e.g. colour) / Input / Output
Voltage (V a.c or d.c.) / Current (A) / Power (W) / Fre-quency (Hz) / Voltage (V a.c or d.c.) / Current (A) / Power (W) / Fre-quency (Hz)

If more than five models, please enter all model details into the spreadsheet supplied with this application. That will allow model details to be electronically captured and minimise the potential for certificate errors

ONCE SIGNED, PLEASE RETURN ALL PAGES OF THIS FORM TO UL AT

/ Application for Electrical Product Certification
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5 MODIFICATION DETAILS (include details of alternate brand / model details for new certificates)
Model ref. / Details of change(s)
continue on separate sheet if necessary
6 SUBMITTED TEST REPORT(S) / NOTE: Reports must be in English
Laboratory / Report # / Issue Date
(dd/mm/yy) / Standard(s) incl. version details
continue on separate sheet if necessary

7 ADDITIONAL COMMENTS

Add any additional relevant comments about your product here

Continue on separate sheet if necessary

ONCE SIGNED, PLEASE RETURN ALL PAGES OF THIS FORM TO UL AT

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8 EESS UPLOAD CONFIRMATION
Complete for certificates recognised under the EESS (see note on the EESS on following page)
I authorise UL International New Zealand to upload data relating to this certificate to the EESS National Database.
I do not want my certificate data to be password protected, when uploaded to the EESS National Database. (If this box is not selected, a password will be set and must be entered by the Responsible Supplier or their agent during product model registration process)
I wish to use the following password for this certificate data: / 6-8 alphanumeric characters only (case sensitive)
(If a password is required but no password is selected, a randomly generated password will be created)
Note: Password protection prevents unauthorised Responsible Suppliers using the uploaded certificate data to register their products on the EESS National Database. It is not for restricting viewing of certificate details, which is publicly available information.
ONCE SIGNED, PLEASE RETURN ALL PAGES OF THIS FORM TO UL AT

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APPLICATION CHECK LIST (customer use)

Please check that you have provided us with the following information and/or documents.

Test Report(s) and supporting certificate(s).
Letter of authorization for agent (if applicable).
Model cross reference declaration (if model number to be certified differs from that in the Test Report)
Marking artwork intended for Australian / New Zealand market (if not included in Test Report)
User Instructions intended for Australian / New Zealand market (if not included in Test Report)
Colour Photographs of product to be certified (if not included in Test Report).
Critical components list (if not included in Test Report).
Current certificate(s) for supply cords, plugs, connectors etc.(if not included in Test Reports)

Note on the Electrical Equipment Safety System (EESS)

Definitions:

a)Certificate of Approval (CoA): Issued for Declared Articles (as defined in the NSW Government Gazette) under the auspices of the NSW Government. Certificates of Approval are recognised under the EESS as equivalent to a Certificate of Conformity until advised otherwise.

b)Certificate of Conformity (CoC): Issued for Level 3 products as defined in AS/NZS 4417 and in accordance with the EESS

c)Certificate of Suitability (CoS): Issued for Level 1or Level 2 products as defined in AS/NZS 4417 and in accordance with the EESSEquipment Safety Rules, and also for products that are neither NSW Declared Articles nor in-scope EESS equipment.

The EESS was introduced in Queensland, Australia, on 1 March 2013. It is expected that other Australian States(but maybe not all) and possibly New Zealand mightadopt the EESS over time.

EESS in-scope electrical equipment must have a Responsible Supplier registered on the EESS database. Responsible Suppliers must be based in Australia (and have an ABN) or New Zealand (and have an IRD number).

The EESS categorises in-scope equipment into Level 3 (High risk), Level 2 (Medium risk) and Level 1 (Low risk). Level 2 and Level 3 products have to be individually registered on the EESS database. Level 3 products require a Certificate of Conformity. Level 2 products require compliance documentation and Level 2 and Level 1 products may have a Certificate of Suitability. Level 3 product registration requires the Responsible Supplier to link their product to a Certificate of Conformity already uploaded to the database by the issuing certification body. If a password is applied when Certificate data is uploaded, the Responsible Supplier or their agent must enter that password when linking their product to the Certificate of Conformity. That allows the Certificate holder to control who may use their certificate data. If no password is applied to a Certificate data, any Responsible Supplier can link to it.

In-scope electrical equipment is defined as:

(1) low voltage electrical equipment designed or marketed as suitable for household, personal or similar use.

(2) It is immaterial whether the low voltage electrical equipment is also designed or marketed to be used for commercial or industrial purposes.

The categorisation of products into Level 2 or Level 3 is set out in AS/NZS 4417.2:2012 or later versions as subsequently amended. Level 1 products are any in-scope equipment not defined as level 2 or level 3.

For further information, contact UL Customer Service at

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TERMS AND CONDITIONS OF CERTIFICATION

AOrdering & Payment Terms. The following Terms and Conditions of Certification detail the conditions and obligations of the applicant and certificate holder, and together with the General Terms and Conditions of Service govern the relationship of the parties under which UL International New Zealand Limited (“the Certifier”) will process applications for certification under the JAS-ANZ accredited ANZ Certification Program Type 1 type certification Program

1. Terms and Conditions. These Terms and Conditions of Certification and the General Terms and Conditions of Serviceshall govern these services. In the event of a conflict between the General Terms and Conditions of Service and these Terms and Conditions of Certification, these Terms and Conditions of Certification shall govern. Certifier reserves the right to assign its rights and responsibilities under these Terms and Conditions without notice

2. Certification Fees. The Certifier will provide the fee for a certification service on request. The fee will be quoted for a single product review submitted with a single set of documentation. Certification fees are non-refundable even where a product fails or certification is stopped by the applicant.

3. Payment options.

ULAG will issue the invoice once certification is completed where prior credit arrangements have been agreed. Otherwise, Applicant will receive and pay a deposit invoice in advance. Invoices will detail payment options.

B.Submissions

1.Applications. With each application for certification, applicant shall include the applicable application form and the following supporting evidence:

Suitable test report(s) demonstrating compliance with applicable standard(s) and more fully described below;
Adequate supporting documentation;
A sample of the product if requested by the Certifier;
Production marking and instruction sheets;
Critical component listing and specifications; and
Detailed colour photographs (if not included in test reports)

The supporting evidence should identify the product and any important design features. The Certifier reserves the right to request additional information in support of any application made.

2. Suitable Test Report(s). Applicant shall provide evidence of compliance with the applicable product standard by submitting an original or an authentic copy of a type test report, in English. The type test report shall cover a representative sample of the product. The submitted tests report(s) must state compliance with the applicable product standard(s). Acceptable test reports include:

Report from an IANZ, NATA, or MRA partner laboratory where the testing is covered by the scope of laboratory accreditation. For the issue of a Certificate of Conformity or a Certificate of Suitability for EESS in-scope products, the test report shall have the required accreditation identification as stipulated by the ILAC/APLAC laboratory accreditation body, or as required under the IECEE CB Scheme.
Report issued by a recognised IECEE CB Scheme laboratory where the testing is carried out by the CBTL and is covered by the scope of laboratory recognition. For Certificates of Approval and Certificates of Suitability (for products that are not EESS in-scope), Applicant shall include copies of the IECEE CB Scheme Certificate when submitting a TMP, WMP or SMT test report. For Certificates of Conformity or Certificates of Suitability (for EESS in-scope products) an IECEE CB Scheme Certificate is required for all test report types. RMT test reports are not accepted.

3. Product sample. Where photographs and supporting documentation do not permit a clear identification of the product and any important design features, the Certifier may request that the applicant provide such evidence or a physical sample. Submitted samples shall be retained for a period of not less than 30 days. After 30 days, the Certifier may dispose of the samples in its sole discretion, unless the Applicant has given specific instructions to the contrary with costs being billed to the Applicant’s account.

C.Certification Process and Deliverables

1. Basis of certification decision. Any certificate issued by the Certifier is based upon conformity to the applicable product standard as demonstrated by the submitted evidence. The applicant takes sole responsibility for all products supplied to the Australian and New Zealand marketplace being the same as the certified sample(s).

2. Consideration of new technology. For products to be issued a Certificate of Approval, Certificate of Conformity or for EESS Level 1 or Level 2 products to be issued a Certificate of Suitability, alternative standards due to new technology require the approval of the NSW Office of Fair Trading or shall be determined in accordance with the EESS Equipment Safety Rules as appropriate. For all other products, consideration may be given to issuing a Certificate of Suitability based on an equivalent applicable standard, where the non-conformance, if any, per the equivalent standard does not affect the safety of the product. Such a decision to certify will only be made upon review of any such request submitted in writing by the CO to the appropriate UL Subject Matter Expert.

3. Certification Body obligations. All applications submitted to the Certifier will be treated with impartiality in a confidential and non-discriminatory manner. If required by the standard, certification details (as contained on the Certificate) will be available to the public upon public request. Additional certification details may be made available to the regulatory authorities upon request. Applicant acknowledges and agrees that JAS-ANZ and Government regulators may audit the Certifier or conduct validation visits to witness its certification process and may inspect records, including the Applicant’s confidential information.

4. Applicant / certificate holder obligations. Certificate holder agrees that it will only make claims of certification for products covered by the certification Program and listed on a valid certificate. Whenever the Certificate Holder provides a copy of the certificate to third parties, they shall provide the certificate in its entirety and not in part. The certificate holder shall not make claims regarding certification (including the use of any mark or logo) which are misleading, unauthorised or which could bring the certification body into disrepute, including but not limited to the sale of products using a pre-allocated certification mark for which a certificate authorising the use of that mark has not been issued. The Certificate holder agrees that it will correct any misleading or inaccurate statements or claims it has made in relation to any certification granted under these Terms and Conditions, at the Certifier’s direction. The certificate holder shall notify the Certifier of any changes to the certificate holder's name or contact details, or to the certified product, by formal application for modification. The certificate holder shall make available any samples, drawings, technical documentation or other records that the Certifier may require in the course of issuing and maintaining product certification.

5. Certification marking. Certificate of Approval numbers issued by the Certifier use the format UxxxxxEA or ULL-xxxxxx -EA. "xxxxx" or “xxxxxx” denotes a unique number specific to an issued certificate. Use of this mark is limited to certified products or their packaging, or to media referencing such products.

6. Certificate validity. Certificates remain valid until the specified expiry date which will not exceed 5years from the date of issuance. Certificates are considered to be withdrawn upon expiry. Extension to the period of validity of an issued certificate may be considered only under special circumstances.

7. Certificate renewal. An issued certificate may be renewed prior to its expiry and application for renewal shall be made using form 39-IC-F0025 together with the applicable fee and documentation. Where the standard has been amended or revised, evidence of compliance with any amended or revised requirements will be required.

8. Use of Regulatory Compliance Mark. The applicant may (in the case of a Certificate of Approval) and shall (in the case of a Certificate of Conformity or Certificate of Suitability) use the Regulatory Compliance Mark (RCM) described in AS/NZS4417 instead of any certification mark issued by the certification body, in which case the requirements of all applicable parts of AS/NZS4417 and applicable regulatory requirements shall be fulfilled.

9. Ownership of certificates. All issued certificates remain the property of the Certifier, with permission given to the certificate holder for use of the certificate for the period of its validity.