APPLICATION FOR NAME OR ADDRESS
CHANGE TO A SIRA CERTIFICATE
This form may be used for name/address changes to an existing Sira Certificate only. If in doubt please contact our Customer Services Department on +44 (0) 1244 670 900 before proceeding.Item / Details
1Equipment name:This should be the nameof the equipment on the certificate.
Several certificate numbers may be written here (including IECEx and QAN/QAR) provided that the change is the same on each. Each additional certificate will be charged an extra fee plus any IECEx levies (Please see section 5).
Include a ‘required by’ date here if this change is needed for a specific deadline. If all documentation is supplied with this application form, certificates are normally issued within 2 - 3 weeks. / Name Change From: / To:
Address Change From: / To:
Please supply label drawing showing new name/address. / Drawing number /
Sheet/ Rev / Description
Please calculate the cost based upon the number of certificates(including QAN/QAR)and the number of IECEx levies, as applicable. / GBP: / USD:
Variation to one certificate / £585 / $1170
Cost of additional certificate (at £75/$150 per certificate)
Cost of IECEx levy(£127.50/$229.50 per certificate)
6Terms and conditions:
6.1 CSA Group Testing UK standard terms and conditions apply, in addition to the following:
6.2 The client agrees to pay the cost specified in row 5 - Estimated cost. CSA Group will conduct an evaluation of thework involved and if it cannot be completed for this sum, CSA Group will contact the client with a separate fixedprice quotation before conducting any work.
6.3 This cost must include the cost of any IECEx charges per variationcertificate/report – if appropriate, these fees will be added to the totalinvoice value sent.
6.4 CSA Group does not guarantee that a certificate covering the modification requested will be issued. This will bedependent upon assessment and checking as part of the normal certification process.
6.5 The client is the manufacturer named on the prime certificate, or acting on behalf of and with permission of the manufacturer. Proof of ownership of intellectual property may be requested.
6.6 Invoices will be sent 100% (payment net 30 days).
6.7 Prices valid until 31st March 2016.
6.8 Name and/or address changes to product certificates must also be applied to any applicable QAN/QAR certificates.If these certificates are not held with CSA Group, the manufacturer must contact the issuing Notified Body to request these changes.
6.9This form will not be accepted unless signed and dated by the client. A Purchase Order (P.O) is also required. Without a P.O, CSA Group cannot start/progress the project.
An electronic signature is acceptable, otherwise please sign, scan and return as a pdf. / Signed: / Date:
Please email this form & accompanying documentation to: or fax to: +44 (0)1244 681330
Continuation of row 4 (if required)
Form 9235 Issue 17