Application for Conformity Assessment of Products for PED, MED, BSP, PPE Programmes

FORM.1/KPW

Issue no. 3 2023-12-13

Please fill out the following information to prepare a quote for product compliance evaluation. Completion of the application does not constitute a commitment to use our services, nor does it involve any fee. The information contained in the application is treated as confidential.

Certification requirements, rights and obligations of the applicant are given on the website.

Concerning the performance of product certification Concerning the extension of the scope of the certificate Concerning the renewal of the certificate

General information:

Applicant status:

Manufacturer ¹⁾ Brand manufacturer ²⁾ Authorised representative ³⁾

Applicant

Address:

Address

Telephone / e-mail:

Telephone number

E-mail address

Share capital (if company legal form required)

Share capital*

Registered at the National Court Register kept by the District Court in

Address*

* *

Vat No.

*

Registered in the Central Register of Business Activity and Information:

Yes No

* - completion of this field is optional

Place(s) of production (if different from point 1):

Yes No

Place(s) of production (if different from point 1):

Applicant

Address:

Address

Telephone / e-mail:

Telephone number

E-mail address

Share capital (if company legal form required)

Share capital*

Registered at the National Court Register kept by the District Court in

Address*

VAT No.* / Numer KRS*:

Vat No.

*

Registered in the Central Register of Business Activity and Information:

Yes No

* - completion of this field is optional

Product subject to conformity assessment with an EU directive or
regulation:

Name of product

1

MED Directive

Module(s):

B D E F G

PED Directive PPER Regulation BSP Regulation

List of requirements and standards that apply to the product:

List of requirements and standards

Certificates held by the Manufacturer:

Certificates*

Readiness date for certification

Date*

* - completion of this field is optional

Additional Information

Have any complaints been made about products within the scope of the certificate during its validity (refers to extension, renewal, renewal of certificate)?

Yes No N/A

Does the Producer have any relationship (e.g. business) with the research contractor whose results are provided with this application? (if applicable):

Yes No N/A

* - completion of this field is optional

Mandatory attachments to be provided by the Organization:

Technical documentation of the product to allow the conformity assessment to be carried out according to the requirements of the Directive/Regulation and other normative documents Tests reports (if tests were performed) Documentation of production quality assurance system Risk analysis and assessment Calculations List of applied materials and components KRS or entry in the Business Register Specimen and/or complete test specimen (if required) Confirmation of BSP pilot competency in performing BSP conformity assessment and verification tests Copy of the authorisation from the manufacturer to act on his behalf in relation to specified tasks (applies to Authorised Representative) Copy of the partnership agreement between the manufacturer and the brand manufacturer (applies to Brand Manufacturer)

Drop the documents here or search on computer

Maximum 15 files

* - completion of this field is optional

Applicant’s declarations:

I undertake to comply with all requirements for applying for product certification/assessment of conformity. I undertake to supply complete technical documentation of the product and all information indispensable for assessment of the product I confirm that an application for conformity assessment was not placed with another notified body. I confirm that the product presented for certification/assessment of conformity was not the subject of cooperation between the Applicant and EU-Cert Sp. z o.o. (e.g. at the design stage) I confirm that the product presented for certification/assessment of conformity is the same type of product that has been subjected to the tests presented in the attached test report and that no significant changes/modifications have been made to the product (if applicable) I confirm that the modifications to the product made since the tests, the results of which have been supplied, have had no significant effect on the performance of the of the product (if applicable) I confirm that I have read the requirements described in the Appendix 3 to PCW-01/BSP, in particular the requirements for manufacturers when carrying out conformity assessment in the BSP certification process (applies only to the Unmanned Aerial Vehicle conformity assessment process)

Autoryzacja przez przedstawiciela wnioskodawcy upoważnionego do kontaktów:

Name and surname:

Name and surname

Telephone / e-mail:

Telephone number

E-mail address

Date:

Date

Position:

Position

Zobowiązania

PART FOR LEGAL ENTITY

I agree to the use by EU-Cert Sp. z o. o. seated in Gdansk of telecommunications terminal equipment and automatic calling systems (e.g. telephone, e-mail), which we are a user of, for the purposes of direct marketing, in accordance with art. 172 of Telecommunications law and sending commercial information.

PART FOR NATURAL PERSONS (ALSO ONE-MAN BUSINESSES):

INFORMATION ON THE RIGHT TO WITHDRAW CONSENT

YOU HAVE THE RIGHT TO WITHDRAW YOUR CONSENT TO THE PROCESSING OF YOUR PERSONAL DATA AT ANY TIME. WITHDRAWAL OF CONSENT WILL NOT AFFECT THE LAWFULNESS OF THE PROCESSING WHICH WAS CARRIED OUT ON THE BASIS OF YOUR CONSENT BEFORE ITS WITHDRAWAL.

Approval no 1

I agree to the processing of my personal data provided in this form by EU-Cert Sp. z o. o. seated in Gdansk for marketing purposes

Zgoda nr 2

I agree to the use by EU-Cert Sp. z o. o. seated in Gdańsk of automatic calling systems or telecommunications terminal equipment, which I am a user of, for the purposes of direct marketing, in accordance with art. 172 of Telecommunications law.

Zgoda nr 3

I agree to receive business information by electronic means from EU-Cert Sp. z o. o. seated in Gdańsk, in accordance with art. 10 of the Act on the provision of electronic services.

Annex 1 - Information clause for natural persons (including sole traders, CEIDG) Go to

* - completion of this field is optional

Application for Conformity Assessment of Products for PED, MED, BSP, PPE Programmes

FORM.1/KPW

General information:

Place(s) of production (if different from point 1):

Product subject to conformity assessment with an EU directive or regulation:

Additional Information

Mandatory attachments to be provided by the Organization:

Autoryzacja przez przedstawiciela wnioskodawcy upoważnionego do kontaktów:

Zobowiązania

Product subject to conformity assessment with an EU directive or
regulation: