ANNEX VF1... DECLARATION OF CONFORMITY No …20
1.
Appliance or fitting /appliance or fitting model (product, type, batch or serial number):
2.
Name and address of the manufacturer and, where applicable, his authorised representative:
3.
This declaration of conformity is issued under the sole responsibility of the manufacturer.
4.
Object of the declaration (identification of the appliance or fitting allowing traceability; where necessary for the identification of the appliance or the fitting, an image may be included): description of the appliance or the fitting.
5.
6.
References to the relevant F4designated standards used or references to the other technical specifications in relation to which conformity is declared:
7.
The F5approved body … (name, address, number) … performed … (description of intervention) … and issued the certificate(s): … (details, including its date, and, where appropriate, information on the duration and conditions of its validity).
8.
In the case of fittings, instructions on how the fitting should be incorporated into an appliance or assembled to constitute an appliance in order to assist compliance with the essential requirements applicable to finished appliances.
9.
Additional information:
Signed for and on behalf of: …
(place and date of issue):
(name, function) (signature):
Word in Annex 5 heading omitted (31.12.2020) by virtue of The Product Safety and Metrology etc. (Amendment etc.) (EU Exit) Regulations 2019 (S.I. 2019/696), reg. 1, Sch. 36 para. 2(48)(a) (as amended by S.I. 2020/676, regs. 1(1), 2); 2020 c. 1, Sch. 5 para. 1(1)