Application Form Kiwa NCP
Registration
Kiwa Nederland B.V. Sir Winston Churchilllaan 273 Postbus 70 2280 AB RIJSWIJK Tel. 088 998 44 00 [email protected] www.kiwa.nl Locatie: Kiwa NCP Dwarsweg 10 5301KT Zaltbommel Tel 088-9985100 [email protected] www.kiwafss.nl
File:
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General Data / Information Name Company ..……………………………………………………………………………....
Focal Point ………………………………………………………………………………...
Address ………………………………………………………………………………...
Posal Code and Place of residence
………………………………………………………………………………...
Country ………………………………………………………………………………..
Telephone Number ………………………………………………………………………………...
E-mail ………………………………………………………………………………...
Website ………………………………………………………………………………...
Criteria 1. Payment
The applicant will receive the registration form and the invoice for the registration. The invoice must be paid within 30 days.
Registration term:
1 year q yes q no
5 years (20% discount) q yes q no
2.
Required documents (Attention: please send the following documents to [email protected]
a.
An authentic copy of the inscription in the company trade register or comparable. This document should not be older than 3 months, counting from the date of this application form.
q yes q no
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b. A description of the component(s) you wish to register.
Brand name Model / Type Product code (see table below)
1.
2.
3.
4.
5.
6.
7.
If you want to register more products, please use a separate form.
1.Adaptor 21.GSM / modem 2.Active IR detector 22.- 3 Control unit 23.- 4.Burglary Detection System (complete) 24.Interface 5.Fire Detection System (complete) 25.dialer / modem / alarmtransmitter 6.Combinationdetector (2 way principle) 26.Installation support 7.CCS 27.Magnet switch 8.Wireless optical indicator 28.Microwave detector 9.Remote control 29.Fog generator 10.n.a. 30.Hold-up alarm 11.Wireless detector 31.Passive IR detector 12.Wireless contact (switch) 32.Panic button 13.Wireless glass break detector 33.Receiver for alarm over IP 14.Wireless interface 34.Lap switch 15 Wireless PIR 35.Siren 16.Wireless siren 36.Alarm systeem (complete) 17.Wireless system (complete) 37.Movement detector 18.Wireless CCS 38.Extension 19.Flasher 39.Ultrasonic detector 20.Glassbreak detector 40.- 41.Power supply
q yes q no
c. A scheme type 2 or 5 certificate from an accredited certification body *: • The certificate must describe the applicable product standards; • Hard and firmware version; • Period of validity of the certificate. * if a test institute is not owned by Kiwa, you must demonstrate that this test institute is accredited by a comparable institute as our Accreditation Council. In case the applicant is not the owner of the report: A declaration of the owner of the report in which he/she declares that the report may be used for the request of the NCP Productregistratie.
q yes q no
d. Valid CE Certificate (up to at least 12 months from the application date) q yes q no
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Declaration
• Undersigned approves the content of this application en the conditions of payment and time of
registration (one or five years).
• In case Kiwa is unable to fulfil the request any cost incurred will be invoiced tot the requestor. After this
period the applicant may require a new period of registration.
• Undersigned will not connect this product with the name of Kiwa NCP, by word and/or writing, before
Kiwa NCP has concluded with the applicant a written agreement, where in mentioned the right to supply
this product with the unique Kiwa NCP number. • Kiwa NCP cannot be hold responsible for any claims arising from the investigation or rejection of this
request.
Name: ..........................................................................................................................................
Function: ..........................................................................................................................................
Date and Place: ..........................................................................................................................................
Signature: ..........................................................................................................................................
