Form 1-ID
INSTITUTE of PRECISION MECHANICS
Certification Department
01-796 Warszawa, Duchnicka 3
Rok zał. 1927
phone: +48 22 663 43 24, 22 663 43 14
e-mail: [email protected]
fax.: +48 22 560 29 22
http://www.imp.edu.pl/cert
Registration date:
Registration
number:
Application date:
APPLICATION
for the certification process of product (process, service) in the field:
1.
Issuance of certificate acc to standard or other normative
document
Number of standard or normative
document
2.
Issuance of certificate allowing to CE or B marking
Number of standard or normative
document
Certification in scope of the system „3” *, „N8” * acc. to PKN-ISO/IEC Guide 67
Certification in scope of the system „1” *, „1+” * acc. to Regulation of Ministry of Infrastructure
Name and address of the manufacturer or importer
Phone, fax, e-mail, name of the competent representative
Tax identification number
Bank account no:
Account (IBAN):
SWIFT:
Name of the item (type, symbol, number of variants, assignment, etc.; in case of larger number of items fill in annex 1 to form
1-ID )
Year of production start
Remarks
Name and address of manufacturer (if application is submitted by importer)
Attention
1.
2.
3.
The Applicant hereby declares that technologies or other specifications of the Institute of Precision Mechanics are/are not*) used during
the items manufacturing process. In case of use the details are given in separate document.
The applicant agrees to fulfill all the requirements of the Certification Department concerning certification procedures and to pay the
certification fee as well as to sign the certification contract.
The applicant declares that the EC Certificate has not been applied for in any other Notified Body.
........................................
place, date
………..…………….......................
APPLICANT SIGNATURE
*stroke out if not needed
Attachments:
Attention:
1. Technical documentation (drawings, technological requirements, descriptions etc.)
2. Report from full tests performed by accredited test laboratory or confirmation of receiving the item for tests.
Put X in proper place In column 1 or 2 regarding scope of certification and give the standard number or number of
normative document.
Annex 1 to the Application fills the Applicant, Annex 2 fills the Certification Division.
INSTITUTE OF PRECISION MECHANICS
Form No. 1-ID, edition 10, March 21, 2012