RCM COMPLIANCE - Market Access (AUS) Pty Ltd

APPLICATION FOR CERTIFICATION / MODIFICATION

Electrical Product Safety Certification Scheme (EPSCS) and the Recognised External Certification Scheme (RECS)

Please complete and confirm details below to appear in the
CBA Certificate of Conformity/Suitability:

Select services required:
NEW APPLICATIONMODIFICATIONRENEWALTRANSFER

Approval/Certificate Holder Details:
Registered Company Name:
ABN (if applicable):
Mailing Address:
Contact for Enquiries:
Telephone No.:
Email:

	Agent Details (if applicable) - please submit Agent’s Authorisation:
Agent Name:
Mailing Address
Contact for Enquiries:
Telephone No.
Email

Manufacturer Details:
Manufacturer Name:
Manufacturer Address:
Contact for Enquiries:
Contact Phone No:
Contact Email:

	Product Information:
Product:
Trade Mark:
Model No.:
Software Version:
Hardware Version:
Rated Voltage:
Rated Frequency:
Rated Power:
Other marking:

Modification and Renewal Application Details:
Original Certificate Number:
Date of Issue:
Original Model No.:
Indicate changes in the design, material or construction from the original approved product:

Checklist for documentation required:
Accredited test reports and certificates (to show compliance to AS standard or equivalent)…………………………
Instruction manuals, rating labels, warnings (English language only)…………………
Colour photographs, certification for critical components ……………………………
Agent’s authorisation (if applicable)……………………………………………………….

TEST SAMPLE WILL BE REQUIRED

DECLARATION by ACMA CB Statement/Certificate of Approval Holder:

I hereby declare that:
- that each article described above complies with the standards nominated,
- that each article of the description specified above for which approval is hereby sought, is identical to the electrical article being the subject of the test reports attached,
- that any modification to components, construction or design of the article will be notified to Certification Body Australia, and
- that I agree and comply with the obligations set out in the CBA Terms and Condition for certification services.
- that Iauthorise Certification Body Australia to use the information provided in this application for registration or updating of the National Electrical Equipment Certification and Registration Database in Electrical Equipment Safety System (EESS), as according to the EESS Scheme Rules or as per the Regulatory Authority requested.

Signature:	`* I confirm my declaration above`	Print Name: Title:
Date:

Certification Fees (excl. GST) – all prices in Australian dollars
New certificate application (Australian telecom approval):	$ 3,200.00 (voice device) $ 2,800.00 (data only device)
Certificate Addendum (simple technical change):	600.00
Certificate Renewal:	750.00
Certificate Modification (non-technical change):	350.00

APPLICATION FOR CERTIFICATION / MODIFICATION

TEST SAMPLE WILL BE REQUIRED

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