CQC/QPCP01.01(1/1)

申请编号:                               生产厂编号：   

Application No:                          Factory No:

CCC认证申请书

Application for the CCC Certification

首次申请     □            再次申请  □

First Application                      Second Application

申请日期/Date：

产品类别/Product sort:

中国质量认证中心

China Quality Certification Centre

1．申请人/Applicant

1.1申请人名称/Name of Applicant:                                             

1.2 付款人名称及地址/Invoice Address:                                    

1.3申请人地址、邮编/Address and post code of Applicant:

1.4 联系人/Person to be contacted:    

1.5 电话/Applicant’s Telephone:

1.6 传真/Fax:

1.7 电子邮件/E-mail:

2. 代理机构或中国办事处名称, 联系人姓名, 地址, 邮编, 电子邮件、电话及传真/Name of Agent or office in China, its contact person, Address, Post Code, E-mail, Tel. No. & Fax No.:                                            

3. 制造商/Manufacturer where the equipment is produced:

3.1制造商名称/Name of Manufacturer:                                                     

3.2制造商地址/Address of Manufacturer:                                     

3.3 联系人/Person to be contacted:

3.4 电话/ Manufacturer’s Telephone:

3.5 传真/Fax:

3.6 电子邮件/E-mail:

4. 制造厂/factory where the equipment is produced:

4.1制造厂名称/Name of factory:                                            

4.2制造厂地址、邮编/Address and post code of factory:                                            

4.3 联系人/Person to be contacted:    

4.4 电话/factory’s Telephone:                  4.5 传真/Fax:                     

4.6 电子邮件/E-mail:

5.产品名称/Name of the equipment:                                      

6.产品商标/Trade mark of the equipment:                                   

7.型号和规格/Model and specification:                                  

8. 申请认证产品的GB标准号/Number of the GB standard for the equipment to be certified:

8.1         安全标准/Standard for Safety:                                                       

8.2         EMC标准/Standard for EMC(如有/If applicable):                                     

9. 申请认证的产品是否有CB测试证书/Has the applying equipment been awarded the CB Test Certificate:

是 /Yes                                             否/No

如果有,给出CB测试证书的编号和获证日期/If  “Yes”, give the number and date of the CB Test Certificate:

a. CB证书号/No. Of CB Certificate:                                               

b. 获证日期/Issued Date:                                                

c.            颁发CB测试证书的认证机构/Name of the NCB issuing the CB Test Certificate：                                                   

10、申请CCC认证的同时，是否申请CB测试证书/ If to apply CB Certificate When apply CCC  Certification:

 是/Yes                                           否/No

11、说明生产厂是否有同类产品获得过CCC证书或CCEE证书或CCIB证书，如果有，请列出证书编号。Please indicate if the factory has ever obtained CCC or CCEE or CCIB certificates, if the answer is yes, then list the certificate No:                    

我们声明我们将遵守中国质量认证中心的认证规则和程序，支付认证所需的申请,试验, 工厂审查及其它有关的费用；中国质量认证中心将不承担获得产品合格认证的制造厂或销售商应承担的任何法律责任。

We declare that we will follow the rules and procedures of the CQC and make payment for the fees arising from the application, testing, inspection and other services.

授权人签章/Authorized signatory                                

申 请 人 承 诺

1）              始终遵守认证计划的安排的有关规定；

2）  为进行评价作出必要的安排，包括审查文件、进入所有的区域、查阅所有的记录（包括内部审核报告）和评价所需人员（例如检验、检查、评定、监督、复评）和解决投诉的有关规定；

3）              仅在获准认证的范围内作出有关认证的声明；

4）  在使用产品认证结果时，不得损害CQC的声誉、不得做使(中国质量认证中心)认为可能误导或未经授权的声明；

5）  当证书被暂停或撤销时，应立即停止涉及认证内容的广告，并按CQC要求交回所有认证文件；

6）              认证仅用于表明获准认证的产品符合特定标准；

7）              确保不采用误导的方式使用或部分使用认证证书和报告；

8）              在传播媒体中对产品认证内容的引用，应符合CQC的要求。

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                                    申请人授权签字：