1. Indicate Details of the Product Under Application for Certification in Fill in This Column

Company seal

<Preparing Attached Certificates>

1. Indicate details of the product under application for certification in “Fill in this Column.”

Shaded areas in “Fill in this Column” do not require entry.

2. Prepare yourself or have other interests prepare the certificates specified in “Documents to be Submitted.” Submit these certificates with this document when applying for Eco Mark Product certification or use.

Submission of attached certificates is not necessary for the items with shade.

3. Prepare certificates referring to the examples provided.

4. The issuer(s) in the“Issued by” column must prepare “Documents to be Submitted.

Item / Documents to be Submitted / Issued by
Planned Display of Eco Mark / < > Yes
< > Product < > Packaging
< > Catalogue/leaflet < > User manual
< > Other ( )
< > No
(If an Eco Mark is displayed, design drawing must be submitted)
(Select where appropriate) / Applicant
Design drawing to be provided (Format free, text)
Item / Fill in this Column / Documents to be Submitted / Issued by
Manufacturer of product / < > Other companies < > Own company
(Select where appropriate) / If developed by other companies, attach Approval of Eco Mark Application / Applicant
If a product with Eco Mark certification under the category is submitted for approval as another brand / Are there any changes in addition to brand name? < > Yes < > No
(Select where appropriate)
(If only the brand name has been changed, the following items do not have to be proved.) / A copy of notice of Eco Mark certification
Documents certifying changes, if any, meets applicable criteria
About application product
Type of printer / ElectrophotographicPrinter
ElectrophotographicMonochrome multi-function printer
ElectrophotographicColor multi-function printer
ElectrophotographicLarge format printers
ElectrophotographicLarge multifunction printers
Type (Machine) / Fill in following blanks for each type (machine) under application.
1.Type, color / Printer / Large Format / Monochrome
< > Multifunction printer / > Color
2. Model of Toner / Toner name (product number): ( )
Toner Containerexchange type
Toner cartridge exchange type
Eco Mark Certification Number ( )
3.Secondary batteries / < > Used /< > Not used
1.Type, color / Printer / Large Format / < > Black and white
< > Multifunction printer / > Color
2. Model of Toner / Toner name (product number): ( )
Toner Containerexchange type
Toner cartridge exchange type
Eco Mark Certification Number ( )
3.Secondary batteries / < > Used /< > Not used
1.Type, color / Printer / Large Format / < > Black and white
< > Multifunction printer / > Color
2. Model of Toner / Toner name (product number): ( )
Toner Containerexchange type
Toner cartridge exchange type
Eco Mark Certification Number ( )
3.Secondary batteries / < > Used /< > Not used
* For the product using the Eco Mark certified Toner cartridge, Attached Certificates shown in the Attachment 1 do not need to submit.
Analysis and testing bodies
General rule / Analysis and testing bodies shall be run in accordance with ISO/IEC 17025(corresponding JIS Q17025). Applicants shall bear the expenses for preparing documents and for the analyses.
Special requirements, if performed at the laboratories of manufacturers / If competent authorities are monitoring the sampling and analysis process, if the analyses and tests are authorized, if the manufacturer has developed a quality system for sampling and analysis and has received the ISO 9001 (corresponding JIS Q9001) certification, or if there are internal standards conforming to ISO9001 for quality systems including sampling and analysis, and measurements are taken in accordance with these standards, the laboratory of the manufacturer is authorized to perform analysis and tests.
Tests / Fill in following blanks for each testing institution.
Powder dust, ozone, Volatile organic compound (VOC) / 1.Name of testing body
2.Address of testing body
3. Laboratory / Maintaining ISO/IEC17025 certification
Operating in accordance with ISO/IEC17025
Maintaining RAL certification
3. If manufacturer is laboratory / A supervisory agency monitors sampling and analysis processes
Has received authorization to perform analysis and testing
Has established a quality system including sampling and analysis and is maintaining ISO9001.
Performs measurements in accordance with a quality control system conforming to ISO9001.
Energy consumption / 1.Name of testing body
2.Address of testing body
3.Laboratory / Maintaining ISO/IEC17025 certification
Operating in accordance with ISO/IEC17025
3.If manufacturer is laboratory / A supervisory agency monitors sampling and analysis processes
Has received authorization to perform analysis and testing
Has established a quality system including sampling and analysis and is maintaining ISO9001.
Performs measurements in accordance with a quality control system conforming to ISO9001.
Noise / 1.Name of testing body
2.Address of testing body
3.Laboratory / Maintaining ISO/IEC17025 certification
Operating in accordance with ISO/IEC17025
3.If manufacturer is laboratory / A supervisory agency monitors sampling and analysis processes
Has received authorization to perform analysis and testing
Has established a quality system including sampling and analysis and is maintaining ISO9001.
Performs measurements in accordance with a quality control system conforming to ISO9001.
Item / Outline of requirement / Fill in this column / Documents to be Submitted / Issued by
4-1-1
(1) / Equipment shall conform to Attachment 1 “3R Design of Equipment”. / < >Yes
< >No / “3R Design of Equipment” / Applicant (in charge of) or product manufacturer (in charge of)
4-1-1
(2) / Plastic casing parts over 25g shall be made of one homopolymer or copolymer. Polymer blends (polymer alloy) are permitted. / < >Yes
< >No / List of plastics
(ExampleA) / Applicant (in charge of) or product manufacturer (in charge of)
4-1-1
(3) / Plastic casing parts over 25g shall be made of four or fewer types of mutually separable polymers or polymer blends. / < >Yes
< >No / List of plastics
(Example A) / Applicant (in charge of) or product manufacturer (in charge of)
If labels, markings, stickers, etc. are difficult to separate, they must be made of the same material as the sections to which they are pasted or made of materials that do not impede recycling / < >Yes
< >No
4-1-2
(4) / Polybrominated biphenyl (PBB), polybrominated diphenyl ether (PBDE) or short-chain chlorinated paraffin (having a chain of 10 to 13 carbon atoms and a chlorine concentration of 50% or more) are not added to plastic casing parts and printed circuit boards as prescription constituents / < >Yes
< >No
4-1-2
(5) / Reused plastic used for at least one component / < >Yes
< >No
Recycled plastic used for at least one component
Name of component ( )
Component weight ( ) g
Percentage of recycled plastic in the component ( ) % / < >Yes
< >No
Respond to hearing on types, etc. of recycled plastic at the request of the Eco Mark Office / < >Yes
< >No
4-1-2
(6) / Polymer containing halogen shall not be used for frame plastic parts weighing over 25g. In addition, organohalogen compounds containing flame retardants shall not be added as prescription constituents. / < >Yes
< >No / List of plastics
(ExampleA) / Applicant (in charge of) or product manufacturer (in charge of)
Exclusion clause b is applicable (meeting Attachment 1). / < >Yes
< >No / All certificates and documentation required by Attachment 1 / Applicant (in charge of)
4-1-2
(7) / For flame retardants used as prescription components in casing plastic parts weighing above 25g, report the name and CAS No. of the component, or report of “ISO1043-4(corresponding JIS standard JIS6899-4)” code number
Also, report the research status (or CAS No., if used) on the use or no-use of relevant flame retardant classified as SVHC (Substances of Very High Concern) by the REACH. / < >Yes
< >No / List of plastics
(Example A) / Applicant (in charge of) or product manufacturer (in charge of)
4-1-2
(8) / Casing plastic parts weighing over 25g shall not contain, as prescription constituents, substances classified as hazardous in the EU,
*Carcinogenic; Category 1-3
*Mutagenic; Category 1-3
*Toxic to reproduction; Category 1-3
in accordance to Attachment 1 of the EC Directive 67/548/EEC,
and substances classified as carcinogenic, mutagenic and toxic to reproduction in TRGS905 / < >Yes
< > neither use Sb2O3
< >Yes
< >use Sb2O3
< >No / List of plastics
(Example A) / Applicant (in charge of) or product manufacturer (in charge of)
Exclusion clause is applicable to antimony trioxide, or meeting Attachment 1. / < >Yes
< >No / All certificates and documentation required by Attachment 1 / Applicant (in charge of)
4-1-2
(9) / Plastic parts shall be marked according to ISO11469 (corresponding JIS K 6999) and in compliance with ISO1043/Parts 1 to 4. (corresponding JIS K6899-1-4).
(This need not apply to the parts with weight less than 25 g or flat area less than 200 mm2, or using reused plastics.) / < >Yes
< >No
The list of marked plastic parts shall be submitted upon request of the Eco Mark Office. / < >Yes
< >No / Marked parts list
(Example 1) / Applicant (in charge of) or product manufacturer (in charge of)
4-1-3
(10) / Using batteries. / < >Yes
< >No
Containing cadmium, cadmium compounds?
Containing lead, lead compounds?
Containing mercury, mercury compounds? / < >Yes/< >No
< >Yes/< >No
< >Yes/< >No
4-1-3
(11) / When batteries installed in the device are out of life or repairs are being made, the battery can be changed or removed without changing the entire printed circuit board it comes with / < >Yes
< >No
No battery
4-1-4
(12) / With regard to heavy metal contained in the toner, cadmium, lead, mercury, hexavalent chromium and their compounds shall not be used. / < >Yes
< >No / List of applicable additives (Example 2) / Toner supplier (in charge of)
4-1-4
(13) / With regard to azo colorants in the toner those (dye or pigment) which may produce amines listed in Attachment 1 due to the reduction of one or more azo groups shall not be used. / < >Yes
< >No / List of applicable additives (Example 2) / Toner supplier (in charge of)
4-1-4
(14) / Certification standards a - c not added in the toneras prescription constituents / < >Yes
< >No / List of applicable additives (Example 2) / Toner supplier (in charge of)
a: The following substances which need to be labelled as “R” in accordance with Attachment I of the EC Commission Directive 67/548/EEC,
・R40 (Limited evidence of a carcinogenic effect)
・R45 (May cause cancer)
・R46 (May cause heritable damage)
・R49 (May cause cancer by inhalation)
・R60 (May impair fertility)
・R61 (May cause harm to the unborn child)
・R62 (Possible risk of impaired fertility)
・R63 (Possible risk of unborn child)
・R68 (Possible risk of irreversible effects)
b: Substances required to be marked by a specified hazard symbol as a whole product pursuant to Annex II in EC Directive 67/548/EEC and1999/45/EC.
c: Substances required to be marked by R43 (May cause sensitization by skin contact) as a whole product pursuant to Annex III, in Directive 67/548/EEC.
4-1-4
(15) / Toner shall give a negative result in the Ames test. / < >Yes
< >No / Test report / Testing bodies
4-1-4
(16) / Products shall be equipped with the toner MSDS (Material Safety Data Sheet). / < >Yes
< >No / Toner MSDS / Tonersupplier (in charge of)
4-1-5
(17) / Tonercartridges and toner containersshall comply with “3R Design of Consumables.” / < >Yes
< >No / “3R Design of Consumables” / Applicant (in charge of) or product manufacturer (in charge of)
4-1-5
(18) / Polybrominated biphenyl (PBB), polybrominated diphenyl ether (PBDE) or short-chain chlorinated paraffin (having a chain of 10 to 13 carbon atoms and a chlorine concentration of 50% or more) are not added to plastic parts of tonercartridges and toner containers as prescription constituents / < >Yes
< >No
4-1-5
(19) / Systems shall be available to collect Toner cartridges or toner containers. / < >Yes
< >No / Certificate indicating explanation of the collecting system of toner cartridges ortoner containers / Applicant (in charge of)
4-1-5
(20) / Material recycling system for tonercartridges is available.
Reuse/material recycling rate of collected toner cartridge parts shall be more than 50% of the entire collected used product weight (excluding toner). / < >Yes
< >No / A certificate indicating the tonercartridges material recycling system
and
certificate showing thetoner cartridge's total mass (exclusive of toner), component reuse / material recycling rate and reuse / material recycling applications / Applicant (in charge of)
Toner cartridges are not used
4-1-5
(21) / The recovery rate of collected toner cartridges or toner containers shall be 95% or more of the entire weight of collected used products (excluding toner). Parts of collected toner cartridges or toner containers which cannot be recovered shall not be simply landfilled but be appropriately processed after the weight reduction / < >Yes
< >No / User's manual (capacity of processing, content of processing, process of weight reduction, appropriate process, etc.) / Applicant (in charge of)
4-1-5
(22) / The toner cartridge shall be labeled in accordance with the Guideline for Labeling Office Machines for Securing Safety. / < >Yes
< >No
< > Toner cartridges are not used
4-1-5
(23) / The product documentation shall indicate the following information on the use of toner cartridges or toner containers (“a.” to “e.”) clearly:
a. Proper use
b. The toner modules should not be forced to open
c. If toner dust leak out as a result of inappropriate handling, inhalation and skin contact of dust should be avoided
d. Measures in case the toner adhere to clothing or hand, or enter eyes or mouth accidentally
e. The toner modules must be kept out of the reach of children. Measures in case children swallow the toner accidentally and treatment in this situation / < >Yes
< >No / Appropriate portions of attachments to the product
4-1-5
(24) / Plastic parts of toner cartridges or toner containers must be made of one monomer or copolymer. / < >Yes
< >No / List of plastics (Example 3) / Applicant (in charge of) or product manufacturer (in charge of)
Difficult to remove labels, markings, and stickers shall be made of the same material as the location on which they are attached, or of a material that does not impede recycling. / < >Yes
< >No
4-1-5
(25) / Toner cartridges and toner containers shall be sealed to prevent leakage of toner during storage and use. / < >Yes
< >No
4-1-6
(26) / The emission rate of dusts during printing phase shall not exceed the prescribed value. / < >Yes
< >No / Measuring method, actual result of the measurement
(Example 4) / Applicant (in charge of) or product manufacturer (in charge of)

Measuring procedure

< >RAL-UZ-122, Annex 2
< >RAL-UZ-171, Annex S-M
< > Large format Device
< > exceeding 70 ipm
For the product which applies to either one of the above, submission as reference value is required only when measured by Table 2. / < >Yes
< >No
< >It is a printer whose printing speed is ipm ≥60 for printing stack form.
4-1-6
(29) / The emission rate of ozone during printing phase shall not exceed the prescribed value. / < >Yes
< >No / Measuring method, actual result of the measurement
(Example 4-) / Applicant (in charge of) or product manufacturer (in charge of)
Measuring procedure
< >RAL-UZ-122, Annex 2
< >RAL-UZ-171, Annex S-M
< > Large format Device
< > exceeding 70 ipm
For the product which applies to either one of the above, submission as reference value is required only when measured by Table 2. / < >Yes
< >No
< >It is a printer whose printing speed is ipm ≥60 for printing stack form.
4-1-6
(28) / The printer's total volatile organic chemical substances (TVOC) / styrene / benzene emission rate during printing phase and standby TVOC emission rate before the device starts printing shall not exceed the prescribed value / < >Yes
< >No / Measuring method, actual result of the measurement
(Example 4) / Applicant (in charge of) or product manufacturer (in charge of)
Measuring procedure
< >RAL-UZ-122, Annex 2
< >RAL-UZ-6171, Annex S-M
< >JBMS-66
< > Large format Device
< > exceeding 70 ipm
For the product which applies to either one of the above, submission as reference value is required only when measured by RAL-UZ-122, Annex 2. / < >Yes
< >No
< >It is a printer whose printing speed is≥60 ipm for printing stack form.
(This item is not applied)
4-1-6
(29) / Attached product documents shall indicate that products satisfy substance emission related criteria 4-1-5(26) to (28), with testing method and above conditions. / < >Yes
< >No
*For large format, the products exceeding 70ipm, or those printing continuous forms exceeding 60 ipm, no need to input the attached documents. / Appropriate portions of attachments to the product
4-1-6
(30) / Caution to the emission of substances and information encouraging users to provide proper ventilation shall be indicated. / < >Yes
< >No / Appropriate portions of attachments to the product
4-1-7
(31) / If paper to be used falls under a. to c. listed below, based on the provisions on quality control of each company, use of at least one or more type of paper shall be possible:
a. Applicable scope “PPC paper, business forms and coated paper for color printers (paper for ink jet printing)” of Eco Mark No. 106 “Paper for Communication Version 3”
b. Applicable scope “Printing paper (Excluding drawing papers included in the “writing and art papers” category designated in the “Paper and Pulp Statistics Annual Report” by the Ministry of Economy, Trade and Industry.) of Eco Mark No. 107 “Printing Paper Version 3”
c. [Information Paper] “Copier paper, forms, coated inkjet color printer paper”, and [Printing Paper] “Non coated printing paper, coated printing paper” of “2. Paper” of the Law Concerning the Promotion of Procurement of Eco-Friendly Goods and Services by the State and Other Entities
Paper possibly used / a / < > b / < > c
manufacturer
Brand name
Eco Mark certification No.
* Eco Mark certification No. shall be specified only when certified paper is used
* If several types of paper are available, indicating the major type. / < >Yes
< >No
the paper listed is not used for this machine
4-1-8
(32) / Repair subcontract systems shall be available, and repairs shall be carried out as requested by the machine users. / < >Yes
< >No
The established system shall provide following information:
- Repair services are available
- Scope of repair (details of services), repair time, costs, how services are provided to users orcontact for obtaining necessary information / < >Yes
< >No / Appropriate portions of attachments to the product
4-1-8
(33) / Supply of the spare parts shall be continued for five years after production of the copier stops. / < >Yes
< >No / Appropriate portions of attachments to the product
4-1-9
(34) / Cadmium, lead, mercury, selenium and their compounds shall not be used as prescription constituents for photoconductor drums. / < >Yes
< >No
Containing cadmium, cadmium compounds?
Containing lead, lead compounds?
Containing mercury, mercury compounds?
Containing selenium, selenium compounds? / < > Yes/< > No
< > Yes/< > No
< > Yes/< > No
< > Yes/< > No
4-1-9
(35) / Systems for collecting and material-recycling of photoconductor drums shall be available. Parts that cannot be recovered shall not be simply landfilled but be appropriately processed after the weight reduction.. / < >Yes
< >No / Documents to describe collection system, details of reuse/recycling/recovery, capacity, details of processing / Applicant (in charge of)
4-1-10
(36) / Plastic materials used for packaging products shall not use the Specific chlorofluorocarbons (5 CFCs), other CFCs, carbon tetrachloride, trichloroethane, and HCFC prescribed in Table 3. / < >Yes
< >No
4-1-10
(37) / Plastic materials used for packaging of products shall not be added with resins composed of halogens containing polymers and organohalogen compounds as prescription constituents. / < >Yes
< >No
4-1-10
(38) / The packaging of products shall give consideration to ease of resource conservation, reuse, and recycling. / < >Yes
< >No / Documents and drawings including packaged state, packaging materials, raw material name used for packaging, and considerations / Applicant (in charge of) or product manufacturer (in charge of)
4-1-11
(39) / The energy consumption of each product shall comply with the criteria. / < >Yes
< >No / Copy of Energy Star report, or certificate
(Example 5) / Applicant (in charge of) or product manufacturer (in charge of)
Standard value
ENERGY STAR Program Version 1.0
ENERGY STAR Program Version 1.1.
-> TEC method / < > OM method
4-1-11
(40) / Power consumption does not exceed 2 W when the switch is off. / < >Yes
< >No
4-1-12
(41) / The equipment whose PPM is ≤70 / < >Yes
< >No
The noise emission shall be measured in accordance with the method specified in ISO 7779 (corresponding JIS X 7779), and the declared A-weighted sound power level “Lwad” specified in ISO 9296 (corresponding JIS X 7778)shall satisfy the formula in the criteria and additionally, shall not exceed 7.5(B).
(Exceptions to counting the number of sheets printed apply to large-format devices (A2 or larger)). / < >Yes
< >No / Declared noise emission
(Example 4) / Applicant (in charge of) or product manufacturer (in charge of)
The equipment whose PPM is 70 / < >Yes
< >No
The noise emission shall be measured in accordance with the method specified in ISO 7779 (corresponding JIS X 7779: 2001), and the declared A-weighted sound power level “Lwad” specified in ISO 9296 (corresponding JIS X 7778) shall be submitted as a reference value.
(Exceptions to counting the number of sheets copied apply to large-format devices (A2 or larger)). / < >Yes
< >No / Declared noise emission
(Example 4) / Applicant (in charge of) or product manufacturer (in charge of)
The product is a BA certified item and the applicant wants to submit the results of tests required by BA. / < >Yes
< >No
The noise emission shall be measured in accordance with the method described in 3.5 of RAL-UZ122 or 3.5.1 of RAL-UZ-171, and the declared A-weighted sound power level “Lwad” specified in ISO 9296 (corresponding JIS X 7778) shall satisfy the formula in the criteria and additionally, shall not exceed7.5(B).
(Exceptions to counting the number of sheets copied apply to large-format devices (A2 or larger)). / < >Yes
< >No / Declared noise emission
(Example 4) / Applicant (in charge of) or product manufacturer (in charge of)
4-1-13
(42) / < > Is a monochrome device
Automatic double-side printing (so-called duplex) is offered as standard, depending on printing speed, or can be arranged as an option;
0<PPM/IPM≤24 Does not apply
25≤PPM/IPM≤44 Standard / option
45≤PPM/IPM Standard / < >Yes
< >No /

Energy Star report copy or Example 5

/ Applicant (in charge of) or product manufacturer (in charge of)
< > Is a color device
Automatic double-side printing (so-called duplex) is offered as standard, depending on print speed, or can be arranged as an option;
0 <PPM/IPM ≤ 19 Does not apply
20 ≤ PPM/IPM ≤ 39 Standard / option
40 ≤ PPM/IPM Standard / < >Yes
< >No
< >Is a device which does not have double-side printing
Has functions to reduce quantity of paper consumption
compressed printing
< > backside printing (manual double-side printing) / < >Yes
< >No
< >Is large-format device or device which accepts stack form
4-1-15
(43) / Users’ information is provided in the documentation attached to the product.
a. Installation conditions for machinery
b. Information on collection, material recycling or disposal of used products.
c. Information on collection, reuse, material recycling, resource recovery or disposal of used OPC kit/photoconductor drums, toner containers (including toner cartridges), etc.
d. Information on collection, reuse, material recycling, resource recovery or disposal of secondary batteries after use
e. Provision of information on paper that can be used (paper size, recommended paper, etc.)
f. Machines are equipped with double-side printing or are available to be upgraded later. For products has such function, the equipment has a function capable of reducing the amount of printing paper used.
g. Detailed product information other than product documentation (electronic media, etc.) is available. / < >Yes
< >No
Secondary battery is used, d in the left column is not required. / Appropriate portions of attachments to the product
4-1-16
(44) / Specific chlorofluorocarbons (5 CFCs), other CFCs, carbon tetrachloride, trichloroethane, and HCFCs listed in the Table 3 shall not be used in the final manufacturing stage, final supply stage of products and circuit boards, and during cleaning of parts for reuse. / < >Yes
< >No
4-1-16
(45) / In manufacturing the applied product, related environmental laws, etc. are followed in the area where the plant performing the final manufacturing process is located. / < >Yes
< >No / Certificate (Example6) / Factory manager of product assembling plant
The state of compliance with the Environmental Laws, etc. for the last five years from the date of application (whether there is any violation) is reported. Or if there is any violation, proper remedies and preventive measures have been already taken, and the related Environmental Laws, etc. are followed appropriately. / < >Yes
< >No
4-1-16
(46) / The content rate of lead, mercury, cadmium and these compounds, hexavalent chromium compounds, Polybrominated biphenyl (PBB) or Polybrominated diphenylether (PBDE) in the product shall comply with ANNEX II (Table 7) of the amended RoHS Directive (2011/65/EU). However, this does not apply to those substances specified in ANNEX III.
However this itemdoes not apply to any recycled or reused components. / < >Yes
< >No
(please clarify the confirmation method)
Applicant (or manufacturer) confirms by tests
Applicant (or manufacturer) prepares “green procurement criteria”, etc. including the applicable materials and confirms the inclusion (amount) with parts supplier
Name of Green procurement criteria:
URL (only if posted):
*if not posted, submit it at the first certification and when revising the criteria.
Applicant (or manufacturer) requires a parts supplier to submit test results of the applicable material.
Other ( )

5. Considerations