Product Certification Form Page 3
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2
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4Determinand
Range (units)
DETERMINANDS
List each determinand measured
and proposed range. More than
one range for each determinand
can be tested if requested. State
if any determinand is to be
excluded from the certification.
APPLICATIONS
Types of processes for which
product is to be certified. (See
Guide and MCERTS standards for
more information).
FIELD TEST
Type of process:
The applicant may propose a
suitable location for the field test
Process operator:
(See Guide and MCERTS
standards for further details).
Site:
EXISTING TEST
REPORTS
:
If existing test reports are to be
offered in support of certification
please provide a copy of the front
page of each report plus the
introductory page. Copies of the
reports (in English) will be
required before a formal quotation
can be prepared.
Note: If submitted reports are not
in English an additional cost will
be incurred.
EXISTING ISO 9000
NUMBER
DATE
CERTIFICATE
Please enclose copy of complete
certificate.
ISSUED BY (Certification Body)
CONFORMITY TO EC
DIRECTIVES ‘CE’
Copies included (yes/no)
EC Declarations of Conformity.
Please enclose copies.
PROVIDE SERIAL NUMBER/BUILD NUMBER OF PRODUCTS THAT
RETROSPECTIVE
THE CERTIFICATION WILL APPLY FROM AND STATE SOFTWARE
CERTIFICATION
STATUS.
Certification can apply to
instruments/systems sold prior to
the issue of an MCERTS
certificate providing no design
changes have been made or the
significance of any design
changes is assessed.
Form 1173 – Issue 12
Page 3 of 4
Sira Certification Service
May 2015
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