EMIRATES CONFORMITY ASSESSMENT SCHEME Application for Registration

For ESMA use only:

Type of Application Application No. Date Received Received By New Renewal Extension Reduction

1. Requirements For Registration

Documents Required for ECAS application
Valid Industry Trade !icense "For Co#panies $it%in &AE'

Additional Requirements for Emirates Quality Mar Application

Controlled Copy of rele(ant MS Manual "Soft Copy in C) )V)' *rief )escription of Manufacturing +rocess

Test Report fro# recogni2ed Testing !a3oratory "%ard and soft copy' )eclaration of Confor#ity 3y t%e Applicant on t%e +roduct"s' for Registration using t%e Applicant4s Official !etter%ead Certification Fees

+lant E,uip#ent !ay-out "scaled ./01'

Vicinity Map of t%e Factory 5uality +lan s%o$ing %o$ to co#ply $it% Specific Standard E(idence of Appro(al fro# ot%er Confor#ity Assess#ent *odies "If appro(ed' Copies of la3els6 #ar7ings6 logos as re,uired 3y Specific Standard

Note: Other requirements maybe required by ESMA if deemed necessary to ascertain compliance to the applicable standards prior
to product registration.

!. Applicant "nformation !.1 Applicant Details

#ame of Esta$lis%ment: &ype of 'usiness: Manufacturer Mailing ( Site Address: Contact )erson: Designation: &el: Fa*: E+mail: Trader Ot%ers 888888888888888888888888

Form No.: CAF-01-01

Issue Date: 10/06/2010

Revision No.:3

Page 1 of 3

EMIRATES CONFORMITY ASSESSMENT SCHEME Application for Registration

!.! Management Representati,e -)erson responsi$le for registration of )roduct.
#ame: Designation: &el: Fa*: E+mail:

!./ Details of Manufacturer of )roduct for Certification -0se Separate )aper if necessary.
#ame of Manufacturer: Mailing ( Site Address: Contact )erson: Designation: &el: Fa*: E+mail:

/. )roducts Details -0se Separate )aper if necessary.

Standard Specifications #o. &itle: Re,. #o.

)roduct #ame: Category &rade('rand #ame Description of )roduct -Descri$e t%e tec%nical description of t%e product as defined $y t%e applica$le 0AE or "nternational Standards. Model #o. &est Report #um$er &ested 'y

Form No.: CAF-01-01

Issue Date: 10/06/2010

Revision No.:3

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EMIRATES CONFORMITY ASSESSMENT SCHEME Application for Registration

1. &erms and Conditions for t%is Application
9:. T%e applicant %ere3y confir#s t%at t%e infor#ation pro(ided in t%is application for# is true and correct: 9:; T%e applicant ac7no$ledges t%at it %as recei(ed and agrees to a3ide 3y t%e follo$ing contractual docu#ents/ 9:;:. 9:;:; 9:;:= Co#pliance of t%e +roduct at all ti#es to t%e &AE National Standards and or to t%e &AE adopted International Standard Co#pliance Re,uire#ents stated in t%e rele(ant Tec%nical <uidelines and MS Re,uire#ents: T%e Applicant %ere3y underta7es to support t%e certification procedure6 pro(ide any infor#ation related to t%is Application as re,uested 3y t%e ESMA6 and allo$ ESMA aut%ori2ed personnel to carry out t%e audit of t%e factory:

9:= If t%e product is no longer in t%e #ar7et6 please infor# ESMA i##ediately in order to $it%dra$ registration: 9:9 T%is Self )eclaration of Confor#ity is considered an application to t%e E#irates Aut%ority for Standardi2ation and Metrology to (erify co#pliance to t%e National or International appro(ed standards: 9:0 T%is Self )eclaration of Confor#ity ai#s at (erifying co#pliance to National or International Appro(ed Standards and t%e essential re,uire#ents: 9:> After re(ie$ing and appro(ing t%e contents of t%is signed )eclaration of Confor#ity and t%e attac%#ents6 a Certificate of Confor#ity is issued: 9:? T%is application is (alid for si@ ">' #ont%s fro# date t%e application $as #ade: Application s%all e@pire if no assess#ent is conducted or if t%e re,uire#ents for product registration $ere not co#pleted: 9:A Fees paid are non-refunda3le:

Signed/ 8888888888888888888888888 Na#e/ 8888888888888888888888888 )esignation/ 8888888888888888888888888 Co#pany Na#e/8888888888888888888888 )ate/ 8888888888888888888888888 Co#pany4s Official Sta#p

2.3 Certification Decision:

Certificate s Recei(ed *y"Na#e Signature'/ 888888888888 Certificate s Released *y"Na#e Signature'/ 888888888888 Official Receipt Nu#3er/ 888888888888888888888 )ate/ 888888888888888888888 No: of Certificates/ 88888888

A#ount +aid/ 888888888888888888888888888

Su$mit Completed Application Form to: Conformity Assessment Department Emirates Aut%ority for Standardi4ation and Metrology -ESMA. +:O: *o@ 9A>>>6 )u3ai6 &AE Tel/ BC?. 9 ;C999=9 Fa@/ BC?. 9;C999;A E-#ail/ confor#ityDes#a:ae

Form No.: CAF-01-01

Issue Date: 10/06/2010

Revision No.:3

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