APPLICATION FOR THE CONFORMITY ASSESSMENT
OF LOW VOLTAGE ELECTRICAL EQUIPMENT (LVD)
according to the Article 8, paragraph 2 of the EU Directive 2006/95/EC as amended

No.:										
	ITC’s Registry Number (do not fill in)

APPLICANT:
Company name:	VAT No.:											
	Registration No.:									
	Registered at:		
Address:	Phone: 		
	Fax:		
Zip Code:			-							e-mail:	@	
Banking with:		Account No.:		
IBAN:		SWIFT Code:		
Represented by:	
Contact person authorized to conduct negotiations:	

Product(s):
Product name:
Type:	
Company name and manufacturer’s address (if different from that of the applicant):

Accompanying documentation:
Required language versions of issued conformity reports:		 Czech       English	 other (            )	
Instructions for use and assembly:		
Comprehensive manufacturing and design data		
Harmonized standards and other technical specifications used (partially or completely) in designing of the product:		
Technical conditions (product and manufacture characteristics, drawings, wiring diagrams, risk analysis, information for user, marking, illustrations, etc.)		
		
Test reports of accredited laboratories		
Other documents and information:		

Applicant’s declaration: 
1.	We agree that product samples will not be returned after assessment.
2.	We agree with the “Obligatory Business Conditions” of ITC and we will abide by them.

    Date of Application	Stamp and signature of applicant’s authorized representative