Please Return This Form Duly Signed by Mail To

ECCA Premium® document N° 1.1

Version 1.0

Created: 27/06/14 (LB)

Approved: 27/06/14 (YB)

ECCA Premium®
quality and sustainability label for prepainted metal

APPLICATIONFORM

Please note that ECCA Premium® licence is prone to an application, initiation and annual licence fees (see attachment “ECCA Premium® Procedural Regulations”).

COMPANY NAME: ------

ADDRESS:------

------

VAT No:------

TELEPHONE NUMBER: ------

TELEFAX NUMBER: ------

WEBSITE: ------

E-MAIL: ------

COMPANY MAIN CONTACTPERSON TO ECCA ------

------

I have read and commit to adhere to ECCA PremiumProcedural Regulations

 YES

Date:Signature:

ECCA PREMIUM® LICENCE SCHEME–QUESTIONNAIRE

Company Name

Head office address
Head office telephone No
Head office fax No
Production sitescovered by the ECCA Premium® licence application
Please select the inspecting organisation you wish to work with. The list of Approved Inspecting Organisations and Inspectors can be found HERE.
Please provide the name of the ECCA Premium® Approved Inspector separately for each production site! / Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Production site name and address:
Contact person:
E-mail:
Tel:
ECCA Premium®ApprovedInspector:
Product(s)* covered by the ECCA Premium® licence application (Brand name(s) or product name(s))
(*) Please supply a copy of the technical data sheet (or similar) of each product together with this application form. Product definition can be found in ECCA Premium® Procedural Regulations. / …
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MANDATORY MANAGEMENT SYSTEMS
Does the company operate a QUALITYManagement System?

 ISO 9001 certificationYes (*)/No

Does the company operate an ENVIRONMENTManagement System?

 ISO 14001 certificationYes (*)/No
 EMAS certificationYes (*)/No

Does the company operate a HEALTH AND SAFETY Management System? Yes / No

 OHSAS 18001 certificationYes (*)/No
 Other (please specify):Yes/No

(*) Please supply a copy of the certificate together with this application form
EUROPEAN STANDARDS RELATED TO COIL COATING (*)
Are you familiar with the following European standards?
EN 10169 Yes / No
EN 1396 Yes / No
EN 13523 series Yes / No
(*) information available on

LIST OF REQUIRED ATTACHMENTS

Technical data sheet (or other document with technical performance level) of each product covered by this application
Copy of a valid ISO 9001 certificate
Copy of a valid ISO 14001 or EMAS certificate
Copy of a valid test certificate of required RC classification
Copy of a valid test certificate of required RUV classification
Copy of a valid Fire Reaction test certificate

A pro forma invoice will be sent to you upon receiving this application form.

The final invoice will be sent when your payment has been received and your application will be handled within one week.

Please return this form by mail to

ECCA Head Office
Rue du Luxembourg 19-21
B - 1000 BRUXELLES(BELGIUM)

by fax to

+32.2.511.43.61

or by e-mail to

For non-ECCA members: when returning the form,
kindly forward your Company's literature too.