Request for Quotation Form

Inquirer
Company:
Address:
Contact person:
Telephone:
e-mail:
Quality of the inquirer (e.g. manufacturer, representative of manufacturer, importer):
Description of the product
Indicate kind of product (e.g. temperature transmitter, barrier etc.)
Kind of equipment
Model(s) or model range
Product specification
Ratings, supply, power, frequency, ambient temperature, etc.
Technical details
Provide documentation that describes the product, like specification sheets, principles of explosion protection, schematic diagrams, constructional details (enclosure, sensor, materials, etc.)
Certification System(indicate ATEX, IECEx or both)
ATEX Group, category, protection type codes, EPL
IECEx protection type codes, EPL
Standards / ATEX / IECEx
List of standards for certification: / EN 60079-series (electrical)
EN 13463-series (mechanical) / IEC 60079-series (electrical)
List here that harmonised standards, other standards or principles that are to be used in order to comply with the Essential Health and Safety Requirements of the ATEX Directive.
For IECEx list latest or second last editions of IEC standards.
For IECEx certification, list countries or areas where the products are intended to be sold (see notes on next page)
Countries or areas:
If the request concerns a variation to an existing certification, please enter the certificate reference number:
Cert No.:
For explanation and for the inclusion of additional remarks and information, refer to next page

Page 1 of 1

Explanation of this Request for Quotation Form:
Fill out this form as completely as possible and send it to our Business Support Office:
orcall +31 (0) 55 539 34 93 for more information at first.
In order to prepare an accurate quotation it is important that the following details are included completely and correctly:
- / group, category and indication Gas/Dust: e.g. <Ex> II 2 G or <Ex> II 1 D;
- / type(s) of protection, group, temperature class (possible or required): eg. Ex ib IIC T4 or
Exta IIIC T125 ºC (if known, also include Equipment Protection Level: Ex ib IIC T4 Gb or
Exta IIIC T125 ºC Da);
- / documentation that describes the product and the product properties, including enclosure details, enclosure materials, schematic diagrams, component lists, etc.
After receipt of the Request for Quotation Form and the required product information, Kiwa ExVision prepares a Quotation including a Test Plan, a list of required test documentation, test samples, a time and cost estimation.
If necessary, our Business Support Office contacts the inquirer for additional information.
The quotation will include an application form that, on acceptation, needs to be filled out as detailed as possible, but at least including:
- / the position of the applicant (manufacturer, representative, importer, distributor);
- / the kind of product (e.g. transmitter, safety barrier, terminal box);
- / the type designation of all products to be included
- / the certification system (ATEX and/or IECEx);
- / for IECEx a list of countries and areas where the product is intended to be sold (see notes)
- / the group and category (Gas or Dust) of the product;
- / the type(s) of protection, group and temperature class or max surface temperature;
- / the standards to be applied (including edition or year of issue).
After receipt of the project acceptation and the application form, the test documentation and the samples, Kiwa ExVision starts the project with a check of the samples and the documentation. It will inform the applicant on any incompleteness.
Notes: / - / IECEx certification gives direct access to Australia and New Zealand only. In some countries IECEx may be accepted without further requirements. In other countries or areas, the IECEx certification and especially the IECEx Test Report is accepted as basis for a national certification, provided the differences for that country or area have been taken into account.
For the listed countries, Kiwa ExVision will take into account the applicable national differences, which means the inclusion of the assessment and test results concerning these differing requirements in the IECEx Test Report.
- / For an ATEX certification based on the IECEx certification, the specific requirements for ATEX (such as equipment group and category marking) will be considered.
- / For North America, certification can be done using Canadian and/or US standards for zones and/or for Divisions. For requirements, add Class(es), Division(s) and Group(s) as appropriate in the box below (“additional remarks and information”). Or contact our Business Support Office for more detailed information regarding such certification.
Additional remarks and information:

Page 1 of 1