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ANNEX IV U.K. EU DECLARATION OF CONFORMITY (No XXXX)(1)

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

2. Name and address of the manufacturer and, where applicable, his authorised representative: U.K.

3. This declaration of conformity is issued under the sole responsibility of the manufacturer. U.K.

4. Object of the declaration (identification of instrument allowing traceability; it may, where necessary for the identification of the instrument, include an image): U.K.

5. The object of the declaration described above is in conformity with the relevant Union harmonisation legislation: U.K.

6. References to the relevant harmonised standards used or references to the other technical specifications in relation to which conformity is declared: U.K.

7. The notified body … (name, number) performed … (description of intervention) and issued the certificate: U.K.

8. Additional information: U.K.

Signed for and on behalf of:

(place and date of issue):

(name, function) (signature):

(1)

It is optional for the manufacturer to assign a number to the declaration of conformity.