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Application of Council Directive(s): 

 
 

  

 

 
 
 

Standard(s) to which Conformity is Declared: 

 
 

 

 

 

 

Manufacturer’s Name:  ................................................................................................................  
 
Manufacturer’s Address:  .............................................................................................................  
 

......................................................................................................................................................  

 
Import’s Name:  ............................................................................................................................  
 
Import’s Address: .........................................................................................................................  
 

......................................................................................................................................................  

 
Type of Equipment:  .....................................................................................................................  
 
Model No.:  ...................................................................................................................................  
 
Serial No.:  ....................................................................................................................................  
 

Year of Manufacturer:  .................................................................................................................  

 

I’ the undersigned, hereby declare that the equipment specified above conforms to the above 

Directive(s) and Standard(s). 

 

 

 

Place: ................................ 

 

 

 (Signature) 
 
Date: ................................. 

 

 

 

  

(Full 

Name) 

 
 

 

 

 

  

(Position) 

 
 

 

 

 
 
 

 
 

 

Application of Council Directive(s): 

 
 

  

 

 
 
 

Standard(s) to which Conformity is Declared: 

 
 

 

 

 

 

Manufacturer’s Name:  ................................................................................................................  
 
Manufacturer’s Address:  .............................................................................................................  
 

......................................................................................................................................................  

 
Import’s Name:  ............................................................................................................................  
 
Import’s Address: .........................................................................................................................  
 

......................................................................................................................................................  

 
Type of Equipment:  .....................................................................................................................  
 
Model No.:  ...................................................................................................................................  
 
Serial No.:  ....................................................................................................................................  
 

Year of Manufacturer:  .................................................................................................................  

 

I’ the undersigned, hereby declare that the equipment specified above conforms to the above 

Directive(s) and Standard(s). 

 

 

 

Place: ................................ 

 

 

 (Signature) 
 
Date: ................................. 

 

 

 

  

(Full 

Name) 

 
 

 

 

 

  

(Position) 

 
 

 

 

 
 
 

 
 

 

Application of Council Directive(s): 

 
 

  

 

 
 
 

Standard(s) to which Conformity is Declared: 

 
 

 

 

 

 

Manufacturer’s Name:  ................................................................................................................  
 
Manufacturer’s Address:  .............................................................................................................  
 

......................................................................................................................................................  

 
Import’s Name:  ............................................................................................................................  
 
Import’s Address: .........................................................................................................................  
 

......................................................................................................................................................  

 
Type of Equipment:  .....................................................................................................................  
 
Model No.:  ...................................................................................................................................  
 
Serial No.:  ....................................................................................................................................  
 

Year of Manufacturer:  .................................................................................................................  

 

I’ the undersigned, hereby declare that the equipment specified above conforms to the above 

Directive(s) and Standard(s). 

 

 

 

Place: ................................ 

 

 

 (Signature) 
 
Date: ................................. 

 

 

 

  

(Full 

Name) 

 
 

 

 

 

  

(Position) 

 
 

 

 

 
 
 

 
 

 

Application of Council Directive(s): 

 
 

  

 

 
 
 

Standard(s) to which Conformity is Declared: 

 
 

 

 

 

 

Manufacturer’s Name:  ................................................................................................................  
 
Manufacturer’s Address:  .............................................................................................................  
 

......................................................................................................................................................  

 
Import’s Name:  ............................................................................................................................  
 
Import’s Address: .........................................................................................................................  
 

......................................................................................................................................................  

 
Type of Equipment:  .....................................................................................................................  
 
Model No.:  ...................................................................................................................................  
 
Serial No.:  ....................................................................................................................................  
 

Year of Manufacturer:  .................................................................................................................  

 

I’ the undersigned, hereby declare that the equipment specified above conforms to the above 

Directive(s) and Standard(s). 

 

 

 

Place: ................................ 

 

 

 (Signature) 
 
Date: ................................. 

 

 

 

  

(Full 

Name) 

 
 

 

 

 

  

(Position)