Procedure:
Process:
Note:

To be completed by the Product Certification Body

NOTICE regarding the Application:

For application, please refer to document ZP 301 "Guideline for Application" (see Annex).

Application for:

☐	Conducting of preliminary examination (V)
Preliminary examination for usability by the technical expert in preparation for a certification procedure for the equipment listed below
☐	Conducting of certification (Z)
Assessment of conformity of the equipment mentioned below, with the applicable standards and specifications in the scope of the certification procedure and preparation of an expert report

Please comment on the questions in all lines. If the opinion is given on separate sheets, it should be referenced in the lines relating to it. This also applies to the enclosed lists.

1	Applicant	Mark of approval ZERT
1.1	Company name (Customer)
1.2	Address
1.3	Contact person Title, name
1.4	Function
1.5	Department
1.6	Tel. / Fax	/
1.7	E-mail
1.8	Envisaged certificate	Select an element.
2	Product information
2.1	Product (e. g. transformer)
2.2	Type designation
2.3	Model designation
2.4	Rated values:
2.5	Reference standards incl. edition on a separate sheet, if applicable
2.6	Further specifications	Annex
2.7	Place of manufacture of the product (precise address)
3	Identification documents
3.1	Technical data	Annex
3.2	Drawing number main drawing (model No., index, date)
3.3	Parts list main drawing (model No., index, date)
3.4	Further details

The applicant agrees to the product certification system (ZP 101) and is willing to pay the costs of the procedure based on the offer. He/she is aware that the certificate issued will be published in a publicly accessible form with information on the manufacturer, product name, certificate number and certificate validity.
He/she is also aware that any misuse of the certificate will be punished by withdrawal of the certificate.
He/she acknowledges the terms and conditions (ZP 300) in their entirety.

After examination of the submitted application documents with a positive result, the Certification Agreement on the Product Certification Procedure ZP 303 will be sent to the applicant.

Date:	Click here to enter a date.
Name: