TÜV SÜD America Inc. Phone: (651) 631-2487

1775 Old Highway 8 NWFax: (651) 638-0285

Suite 104E-mail:

New Brighton, MN 55112

TUV SUD America – Request for quotation

Please complete the applicable items on this form and return to: Maja Bland

If you have questions or need help completing this form please call: 651-604-3488 and email .

General Information

Company / Billing Address (if different)
Address
City
State
Zip
Phone
Fax
Email
Manufactured at this address?
(if not please list)
Product Name/Description
Model Number(s)
Website (if available)
Which directives apply / Low Voltage EMC Machinery Medical Device Pressure
ATEX Other:
Testing Required / EMC Intentional Radiator Electrical Safety Environmental
(transmitter)
Product Dimensions / Height Width Length Weight
Power Requirements / 120 vac 220-240 vac 3 phase external dc internal dc
terminal block detachable cord non detachable cord 50 hz 60 hz
Current Requirement / Amps (nominal) Amps (max)
Environment / Normal (dry) Damp/Wet Hazardous
Similar to previous unit / Yes No Test report #
How will product arrive / Drop Off Mail In Truck Other

EMC Testing

Market Submittals / US(FCC) Canada(IC) Europe(CE) Japan(VCCI) Taiwan(BSMI)
Australia (C-Tick) e-Mark R&TTE Mexico Korea (Mic)
Report Required / Data Only Test Report (immunity) Test Report (emissions) other
Standards Required
Will you attend testing / Yes No Willing to work nights Willing to work weekends
Request start/end dates / Start Date End Date
Input/Output Ports
(Ethernet, power etc) / Number of external I/O cables Number of Power Cables
Highest Oscillator Frequency / Clocks Oscillators Switching Power Supplies
Modes of operation / One More than one explain
Does the unit have a laser / Class (1,1m,2,2m,3R & 3B, 4) Approved: Yes No
Estimated set up time
Reset/Recover time
Does the unit have a radio / No YES – if yes fill out transmitter information below

Transmitter Information (if applicable)

Operating Frequency
Type of Modulation / (AM, FM, FSK, GSM) Analog only Digital only Analog & Digital
Grantee Code / Number Do you need assistance to apply Yes No
Spread Spectrum / Yes No
Bandwidth
Transceiver / Yes No
Licensed / Yes No
Does unit have modular device approval / Yes No
Maximum Power
Type of output / Fixed at factory Changeable by user Switched to specific level
Data rate (if applicable)
Number of antennas / Detachable Yes No
Transmitter Submittals / FCC IC R&TTE Modular Device SAR
Is SAR Testing Required / Yes No

Electrical Safety Testing

Which directives apply / Low Voltage EMC Machinery Medical Device
Other:
Which standard apply
Compliance needs for / US Canada European Union Europe (other) Mexico
Japan Taiwan Korea Australia CB Scheme other
Documentation required / CE Test Report Certification (CUE mark) CB Report other
Does the unit include a PLC
If yes: Is the PLC certified / Yes No
Yes No
Are thermal cut outs used
If yes: How do they reset / Yes No
Manual Auto
Does the unit use batteries
If yes: What type / Yes No
Are there fans
If yes: Are they certified / Yes No
Yes No Number
Are there motors
If yes: Are they certified / Yes No
Yes No Number
Is the equipment enclosed
If plastic: Flammability Rating / No Metal Plastic Both
Rating:
Are there telecom interfaces
If yes: Port ID/Network Type / Yes No
Port ID Network Type
Port ID Network Type
Are barriers provided between TNV and SELV circuits
If yes: Detail Below / Yes No
Component (cap, opto etc) / Type / Certified
Yes No
Yes No
Yes No
Yes No

Electrical Safety Testing (continued)

Is the power supply certified
If no: Complete Power Supply Section below / Yes No
Are any inverters or DC to DC converters certified
If no: Complete Power Supply Section below / Yes No N/A

Power Supply Units (PSU)

Manufacturer/Model Number
Linear Switcher / Class I (earthed) Class II (double insulated)
Class III (low voltage)
Detail Power Supply Unit outputs
Voltage Current / Voltage Current
Voltage Current / Voltage Current
Max Total Power
Specify construction type for each barrier
Are there barrier opto isolators
If yes: Are they certified / Yes No
Yes No
Are there other safety critical components
If yes: Are they certified / Yes No
Yes No

Management Service • Product Service • Industry Service • Automotive