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APPLICATION FOR CERTIFICATION / MODIFICATION
Electrical Product Safety Certification Scheme (EPSCS) and the Recognised External Certification Scheme (RECS) Please complete and confirm details below to appear in the CBA Certificate of Conformity/Suitability:
Select services required:
*
NEW APPLICATION
MODIFICATION
RENEWAL
TRANSFER
Approval/Certificate Holder Details:
Registered Company Name:
ABN (if applicable):
Mailing Address:
Contact for Enquiries:
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:
Manufacturer Address:
Contact for Enquiries:
Contact Phone No:
Contact Email:
Product Information:
Product:
Trade Mark:
Model No.:
Rated Voltage:
Rated Frequency:
Rated Power:
Other marking:
Modification, Transfer 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.
Written consent from current owner (Certificate transfer)
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 Condition for certification services. - that Iauthorise Certification Body Australia to use the information provided in this application for registration or updating of the National Electrical Equipment Certification and Registration Database in Electrical Equipment Safety System (EESS), as according to the EESS Scheme Rules or as per the Regulatory Authority requested.
Signature:
I confirm my declaration above
YES
NO
Print Name:
Title::
dd/mm/yyyy
MM slash DD slash YYYY
Certification Fees (excl. GST) – all prices in Australian dollars
New application: 1,450.00 Addendum (technical change): 480.00 Modification (non-technical change): 350.00 Certificate Renewal (after 5 years): 750.00 Transfer of Certificate 350.00
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