QUOTATION REQUEST FOR CERTIFICATION OF PRODUCTS /
PRODUCT DATA
RELATED PRODUCTS AND QUANTITIES THAT WILL MAKE PART OF THE SCOPE OF CERTIFICATION:
COUNTRY (IES) DESTINATION:
NOTE: ATTACH CATALOGUES OR DRAWINGS OF THE PRODUCTS, TECHNICAL CHARACTERISTICS (VOLTAGE, CURRENT, POWER, ETC.), TECHNICAL MANUALS AND GENERAL NOTES.
DESIRED MARKOR SERVICE
INMETRO / ANATEL / TÜV – CE
(EUROPE) / c-TÜV-us
CANADA/UNITED STATES / TÜV – FCC
/
Please fill out pages 2 and3 /
C
US
C + US /
TÜV – S
ARGENTINA / TÜV – NOM
(MEXICO) / TÜV – EMC (ELECTROMAGNETIC COMPATIBILITY) / TÜV SAFETY / OTHERS
/ / / / CCC (China)
GOST-R (Rússia)
Others (please, describe)
Inmetro DEC
/ TÜV RoHS / TÜV RoHS / Inmetro CSE / NR-12
/ / / Attest of Compliance NR-12
Inspection according NR-12
Please fill out all fields of this form
DATA OF THE APPLICANT
Name
Address / Number / Complement
Neighborhood / City / State/Province
ZIP Code / Phone / Fax
Contact technical name / Position / e-mail
Contact commercial name / Position / e-mail
Legal Representative Name (listed in the Social Contract and / or Attorney)
DATA OF THE MANUFACTURER
(Complete only whether different from applicant)
Name
Address / Address / Address
Neighborhood / City / State/Province
ZIP Code / Phone / Fax
Contact technical name / Position / e-mail
Contact commercial name / Position / e-mail
Legal Representative Name (listed in the Social Contract and / or Attorney)
BILLING INFORMATION
Name
Address / Number / Complement
Neighborhood / City / State/Province
ZIP Code / Phone / Fax
Contact name / Phone / e-mail
CSE – Special Situations Certificate for Imported Products for Explosive Atmospheres
Place of Inspection: At TÜV At applicant
REQUESTED DOCUMENTS:
  • Certificate of compliance of the product for use in explosive atmospheres or any other equivalent document in the country of origin, issued by third parties, and valid for the complete equipment (The applicable standards mentioned on Ex Certificates shall be in the last version
updated);
  • Updated ISO 9001 Certificate of the plant of production or the last follow-up inspection report from the foreign certification body;
  • PQAN - Product Quality Assurance Notification (for ATEX certified products);
  • Entry Invoice of the imported products (without exceeding 20 units of the product);
  • Marking identification drawing according to Annex C of Administrative Rule no. 179.
  • Instructions/installation manual of the products.

NOTES
  • The Special Situations Certificate for Imported Products for Explosive Atmospheres (CSE) can be issued with up to 20 (twenty) units, for the same product, within a period of 180 (one hundred eighty) days.
  • The applicant shall formally confirms that does not requested for another Notified Body, in this period, the Special Situations Certificate for Imported Products for Explosive Atmospheres (CSE) for the same product.
  • Certificates from differents Notified body for the same product won’t be accept for effect of issuance of Special Situations Certificate for Imported Products for Explosive Atmospheres (CSE) within a period of 180 (one hundred eighty) days.

EUROPEAN MARKET
Product description
Models:
Difference between the models:
Do you wish that TÜV Rheinland classify your product and checkwhich are the directives andapplicable standards? YES NOT
If this information is already of you knowledge, please specify:
Directive / Standard / Has a test report? / Do you wish that TÜV schedule the tests to be performed?
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
YES NOT / YES NOT
Do you wish evaluation of the documentation of Technical file? YES NOT
Do you wish workshop / sensibilization inCE marking? YES NOT
Do you wish conformity marking?
TÜV SAFETY / TÜV – EMC (ELECTROMAGNETIC COMPATIBILITY) / ROHS / ROHS – QC080000
Has a test of risk analysis? YES NOT

Name:______Signature:______

Request date:______

This form shall be signed and sent per fax or email.