CNEXCB-FM-200EC申请书

CNEXApplication Form申请书PART A:部分A:SERVICE REQUIRED服务项目Please select below what service you require:请选择下面所列的项目▣IECEx Scheme▣Ex Luminaire☐Ex EquipmentIECEx认证防爆灯具防爆设备☐Ex Motor☐Ex Instrument☐Ex Control system防爆电机防爆仪表防爆控制设备Certificate of Conformity☐Unit Verification☐Test report(s)合格证单元检验合格证试验报告☐New Product☐Changed Product新产品产品变更Production Quality Assessment (QAR)生产质量体系评审(QAR)☐Quotation Required报价PART B:部分B:APPLICATION INFORMATION申请信息Name and full address of the Applicant*:申请人姓名及地址Registration number:if applicable)注册编号（若适用）Name and contact details of the contact person::联系人姓名及详细信息*If the applicant is not the manufacturer,evidence is to be provided that the applicant is authorised to act on behalf of theManufacturer for the application and the Manufacturer undertakes to abide by the Scheme's Rules.*如果申请人与制造商不是同一人，请提供作为制造商授权人的证明，制造商承担相应认证的法律法规Name and full address of the Manufacturer(f different from applicant:)制造商名称及地址全称Additional manufacturing locations:其它的生产制造厂地Name and contact details of the contact person:联系人姓名及详细信息Type of Equipment:设备类型(If space insufficient,please attach extra sheets)CNEX-CB-FM-200ECPage 1 of 5