特种设备制造许可申请书(英文)

TSZS0092003 Application Form For Manufacture Licensing of Special Equipmentof the Peoples Republic of ChinaManufacturer: Equipment Category: Type of application: Application Date: General Administration of Quality Supervision, Inspection and Quarantine of the Peoples Republic of ChinaBasic Conditions of Application ManufacturerFull Name of Manufacturer Address of Manufacturer Country / RegionCorporateRepresentativeLiaison Phone NumberFacsimile NumberE-mail AddressPost CodeWebsite HomepageDate of Establishment Total EmployeesManagement RepresentativePosition of Management RepresentativeRegistration or Certification AchievedItems under Registration or CertificationCertification OrganizationDate of issueDate of ExpirationApplication Agent Full Name Address Organization Code Corporate RepresentativeRepresentative on Manufacturers Behalf Phone NumberE-mail AddressFacsimile Number Category of Licensing Applied( Mark “O” in the column of “Licensing Held” for licensing holder, and mark “” in the column of “New Applicant” for new application, license renewal or application for scope extension)Category ClassificationLevelScope Typical ProductsLicensing Held New ApplicantType Testing OrganizationDeclaration and Signature of ApplicantI hereby declare that my party is willing to apply for the Manufacturer Licensing by following the provisions on the “Supervision Administration Regulation for Manufacture of Boilers and Pressure Vessels”. My party will accept the review, survey and assessment, product (sample) inspection & testing, and engage our full guarantee for product quality by following relevant regulations, and accept subsequent surveillance & product supervisory inspection, and provide the necessary working conditions, and pay the relevant fees and expenses as stipulated.Corporate Representative of Applicant: Position: Date: (Signature)Sales in Recent Four Years within Chinas MainlandYearCategoryQuantityInstallation LocationManufacturers ResourcesArea of Manufacturer （） Area of Workshop（） Area of Radiography Testing Exposure Room() Design Capacity (Category)Technician ( Number) Designer (Number)Professional Personnel (Number)Quality Responsible Engineer (Number)Welding Technician(Number)Inspector ( Number)NDT Examiner (Number)Welder and Welding Operator (Number)Composition of Each DepartmentDepartmentPerson in ChargeStaff QuantityCertification of the NDT Examiner, Welder and Welding OperatorOf NDT Examiner or Welder NameCertified OperationMethod /TypeLevel/Welding Process(es)Date of ExpirationList of Quality Responsible EngineerNameEducationMajorResponsibility Main Manufacture Equipment(s) No.Name of EquipmentCapacityQuantityMain Inspection and Testing Instrument and Equipment No.Name of Instrument and Equipment Capacity QuantityCapability of Self-Calibration of Instrument and Equipment No.Name of Instrument and Equipment Calibration ScopeSub-contract No. Sub-contracted ItemName of Sub-contractorSubmitted DocumentsNo.Document TitleNumber of Sheet or PageAcceptance views and result of General Administration of Quality Supervision, Inspection and Quarantine of the P. R. of China: 同意受理特种气瓶（B3，限缠绕气瓶）制造许可申请。Acceptance of Li