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Infrastructure Technologies Clayton, Victoria, Australia +61 3 9544 1128 AF-F001 CSIRO VERIFICATION SERVICES - ACTIVFIRE® SCHEME PRODUCT CERTIFICATION - PROJECT/PROSPECT REGISTRATION REQUEST AF-F001-ProjectRegistration AF-F001 issue date: 1-Oct-2017 Page 1 of 1 © CSIRO Australia, 2017 Print and scan the SIGNED document and email to: [email protected] Instructions 1. Save to your desktop. Open with Adobe PDF Viewer (or similar), then complete the form. 2. If the business entity of the Applicant is different to the Producer, CSIRO will contact the Producer of the product(s) where necessary for the purposes of the evaluation and verification processes. 3. Print and scan the signed document and email to [email protected] Terms of service delivery This form should be completed with reference to the CSIRO Verification Services terms and conditions as contained in the following documents. 4. CSIRO Verification Services - ActivFire® Scheme Terms of Service. a. for Domestic (Australian) Clients/Customers click link… AF-D000.D b. for Foreign (International) Clients/Customers click link… AF-D000.F 5. Rules governing ActivFire Scheme click link… AF-D001 Applicant The Producer, or business entity authorised by the Producer, intialising and/or facilitating a request and submission for the verification processes required to certify a product Legal name: 1 Company registration num.: Trading name: 2 Aust. Business Num. (ABN): Address Premises: Postal: Line phone: Web site URL: Email address: Applicant contact Name: Position: Line phone: Mobile phone: Email address: Producer The business entity responsible for the design management, manufacturing specifications and quality management/control associated with the conformity and production of a product Legal name: 1 Company registration num.: Trading name: 2 Aust. Business Num. (ABN): Address Premises: Postal: Line phone: Web site URL: Email address: Producer contact Name: Position: Line phone: Mobile phone: Email address: Primary manufacturing unit The Producer, or a business entity contracted with the Producer, providing the total, substantive or final production/assembly process of a product Legal name: 1 Company registration num.: Trading name: 2 Aust. Business Num. (ABN): Address Premises: Postal: Line phone: Web site URL: Email address: Agent/distributor An Australian business entity, authorised by the Producer, that is designated on the Register as a point/source of supply and support for the certified product Agent(s)/distributor(s) shall be Australian business entit(y/ies) authorised by the Producer and as established in the course of the verification validation process. Product details Enter items OR attach brochures or descriptive literature with product designation details… Item Trade brand Model / Series Product type 1 2 3 … Attach continuation document of product designations… Product conformance criteria for certification (to which the Producer attests conformance, or seeks to do so) Enter items OR at this point, we ("the Applicant") are uncertain, which standard(s)/specification(s) are relevant to the attestation of conformity of our product(s) Item Designation of product standard and/or specification 1 2 3 … Attach continuation document of product conformance criteria… Applicant’s authorisation and declaration As the Applicant requesting registration of a product certification project, under the CSIRO Verification Services - ActivFire Scheme, I acknowledge and accept the following. 1. If the business entity of the Applicant is different to the Producer, I authorise CSIRO to contact the Producer of the product where necessary for the purposes of the evaluation and verification processes. 2. The period of time required for processing of a project registration request, may increase if, a. research, referral or consultation is necessary to determine appropriate standard(s)/specification(s), relevant to evaluating and verifying the conformity of the product(s) for regulatory/system design requirements or other intended purpose. b. the type of product is of an unfamiliar, unusual or complex technology or the scope of product(s) proposed for submission is ambiguous, incomplete or inadequately defined for the purposes of evaluation and verification. Signed By (Print name) On (date) 1 Company registration number/code issued and verifiable by a statutory agency of the country designated in the company address. 2 Australian Business Number (ABN) as applicable to Australian business entities.
