CB测试证书申请书

Application for CB Test certificate

CQC/QPCPO9.04(1/1）

Our reference 申请书编号 Date 申请日期

SCHEME OF THE IECEE FOR RECOGNITION OF RESULTS OF TESTING TO STANDARDS FOR SAFTY OF ELECTRICAL EQUIPMENT (CB-SCHEME).

国际电工委员会电工产品合格测试认证组织IECEE-关于电工产品测试证书相互认可体系

Applicant name

申请人名称:

Applicant address

申请人地址:

Tel. 电话号 Fax传真号 E-mail

Contact person name/ Tel./E-mail

联系人姓名及电话/ E-mail

Manufacturer’s name/address

制造商名称及地址

Tel. 电话号 Fax 传真号 E-mail

Factories name and address:

工厂名称及地址:

Product name 产品名称

Trade mark产品商标

Model and specification 型号规格

Relevant Standard 标准号/及增补件

The country which the product will be export to

拟出口国家:

Components/spare parts used in the appliance

整机的安全元器件清单:

Object/part 元器件名称	Manufacturer Trade mark 制造厂/商标	Type/ model 型号规格	Technical data 技术数据	Standard 采用标准	Mark of conformity 认证标志

Other information of value to the NCBs (such as business license, catalogues, price lists, advertising material, informatory pamphlets, lists of components or spare parts, instructions for maintenance and repair, photographs, drawings, circuit diagrams) is enclosed (preferably in quadruplicate) and is listed below:

提供给NCB的其它有价值的信息（企业注册复印件, 产品目录、价格表、宣传材料、小册子、元件或备件表、维修指南、照片、图纸、线路图）作为申请书附件（一式二份）

备注 Note： 1. 我们申请进行现场测试，测试形式为 TMP WMT We would like to apply for on-site testing 测试实验室名称： 编号： Name of Lab: Code given by CQC: 2. 我们同意本产品获得CB证书后将证书内容作为公共信息公布在IECEE网站上，所有人员均可查阅。 We agree that, after obtaining CB certificates for the products involved in this application, content of the certificate will be published on the IECEE website as public information, without any access restrictions. 同意 不同意 Agree Not agree

We declare that we will follow the rules of the CB Scheme and CQC’s relevant regulation and procedure. And make payment for the fees arising from the application, testing and other items related to the certification. CQC will not be held liable for any responsibility that should be taken by the certified manufacturer of sales agent.

<, SPAN lang=EN-US> 我们声明愿意遵守CB体系的规则及CQC 的规则程序.并支付所需费用.中国质量中心(CQC)将不承担获得CB测试证书的制造厂或销售商应承担的任何法律责任.

Signature

签 字