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Regulation 47(1)(c)

[F1SCHEDULE 1KE+W+SDeclaration of Conformity

Declaration of Conformity (No. XXXX)E+W+S

1.  Instrument model/instrument (product, type, batch or serial number):

2.  Name and address of the manufacturer and, where applicable, his authorised representative:E+W+S

3.  This declaration of conformity is issued under the sole responsibility of the manufacturer.E+W+S

4.  Object of the declaration (identification of the instrument allowing traceability; it may, where necessary for the identification of the instrument, include an image):E+W+S

5.  The object of the declaration described above is in conformity with the relevant statutory requirements:E+W+S

6.  References to the relevant designated standards or normative documents used or references to the other technical specifications in relation to which conformity is declared:E+W+S

7.  The approved body (name, number) performed … (description of intervention) and issued the certificate:E+W+S

8.  Additional information:E+W+S

Signed for and on behalf of: (place and date of issue): (name, function) (signature):]