Application for Product Testing
1.
Reference Number:
Name of Applicant
Address
Address
Town
Country
Post Code
Telephone
Fax
Email
Contact
Position
2.
Name of Manufacturer (if different from applicant)
Address
Address
Town
Country
Post Code
Telephone
Fax
Email
Contact
Position
3
Name of Factory (if different from manufacturer)
Address
Address
Town
Country
Post Code
Telephone
Fax
Email
Contact
Position
4
Product Name
Model Number
5
Input Voltage, Current and Frequency
Power consumption
Output Current and Voltage
Highest Frequency generated or used within the product
6
EMC Testing required
2004/108/EC EMC Directive
1999/5/EC RTTE Directive
FCC
IC
RCM
E/e-mark
BSMI
VCCI
CCC/CQC
Other (please specify)
7
Safety Testing
2006/95/EC Low Voltage Directive
2006/42/EC Machinery Directive
GS
CB
UL + cUL
CCC
cTUVus
ETL + cETL
SAA
CSA
PSE
NOM
SPRING
Other (please specify)
8
Energy Efficiency Testing
LED Integral Lamps
LED Luminaries
Compact Fl
ourescent Lamps
Lighting Facts
DLC
874/2012
ErP EU No 244/2009 EC No 1194/2012
EELS
ELI
Other
9
Information provided with the application
Adapator Safety Certificate
Block Diagram
Schematic and Operation Description
Label and Location on Product
FCC Grantee Code
IC Company Code
PCB Layout
Bill of Materials
Exploded Diagram
FCC ID(14)
IC UPN (8" - ")
Critical Component List & Cert.
Spec of Transformer
PCB Placement
10
Report Language
First Langauge free, £500 for each additional languge
English
Chinese
11
Report Delivery
Express £15 fee (in advance invoiced with the testing
Express Address:
Same as Applicant
Same as Manufacturer
Same as Factory
Collection
Email
12
Sample handling after testing
Valuable or Hazardous samples should be collected
Samples will be disposed of three months after testing is complete, if uncollected
Collection
Shipping
Disposal by CTI
13
Invoice Delivery
Same as Applicant
Same as Manufacturer
Same as Factory
Other (Please Specify)
Any other information
Name of authorised representative
Position
Date
