APPLICATION FOR CERTIFICATION / MODIFICATION Electrical Product Safety Certification Scheme (EPSCS)

Electrical Product Safety Certification Scheme (EPSCS)

Please complete and confirm details below to appear in the CBA Certificate of Compliance:
Select services required:
- NEW APPLICATION
- MODIFICATION
- RENEWAL
Approval/Certificate Holder Details:
Registered Company Name:
ABN (if applicable):
Mailing Address:
Contact Person:
Telephone No.:
Email:
Agent Details (if applicable) - please submit Agent’s Authorisation:
Agent Name:
Mailing Address
Contact for Enquiries
Telephone No.
Email
Manufacturer Details:
Manufacturer Name & Address
Factory Name & Address
Product Information:
Product:
Trade Mark:
Model No.:
Rated Voltage:
Rated Frequency:
Rated Power:
Other marking:
Modification and Renewal Application Details:
Original Certificate Number:
Date of Issue:
Original Model No.:
Indicate changes in the design, material or construction from the original approved product:
Checklist for documentation required:
Accredited test reports and test certificates
Max. file size: 128 MB.
Instruction manuals, rating labels, warnings (English language only)
Max. file size: 128 MB.
Colour photographs, certification for critical components
Max. file size: 128 MB.
Agent’s authorisation (if applicable)
Max. file size: 128 MB.
Other
Max. file size: 128 MB.
Test sample may be required
Declaration by Approval/Certificate Holder
I hereby declare: - that each article described above complies with the standards nominated, - that each article of the description specified above for which approval is hereby sought, is identical to the electrical article being the subject of the test reports attached, - that any modification to components, construction or design of the article will be notified to Certification Body Australia, and - that I agree and comply with the obligations set out in the CBA Terms and Conditions for certification services.
Declaration:
I confirm my declaration above
- YES
- NO
Print Name:
Title::
dd/mm/yyyy
Certification Fees (excl. GST) – all prices in Australian dollars
New application: 2,350.00
Addendum: 480.00
Renewal: 750.00
Modification (non-technical change): 350.00

APPLICATION FOR CERTIFICATION / MODIFICATION Electrical Product Safety Certification Scheme (EPSCS)

Approval/Certificate Holder Details:

Agent Details (if applicable) - please submit Agent’s Authorisation:

Manufacturer Details:

Product Information:

Modification and Renewal Application Details:

Checklist for documentation required:

Test sample may be required

Declaration by Approval/Certificate Holder

Declaration:

Certification Fees (excl. GST) – all prices in Australian dollars

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