CCC测试认证申请表CCCApplicationForm

1、CCC测试认证申请表 CCC Applicatio n Form首次申请口再次申请匸1First Applicati onSecond Applicati on申请人相关信息 (Information of the Applicant)申请人名称仲文)：Name of Applica nt(Ch in ese) :申请人名称(英文)：Name of Applica nt(E nglish)付款人名称：Name of Payer付款人地址：Address of Payer :申请人地址仲文)：Address(Chinese):申请人地址(英文)：Address(English):申请人组织机构代

2、码：邮政编码：Post Code :国家或地区：所在省市：联系人仲文)：Pers on to be con tacted:联系人(English):Pers on to be con tacted :E-mail : 仃 elephone): (Fax): (Mobile Phone):代理机构或中国办事处信息(Age nt or Office in Chi na)代理公司名称：Compa ny Name代理公司地址：Compa ny Address :组织机构代码：代理机构批准编号：邮政编码：Post Code :联系人：Pers on to be con tacted :E-mail :

3、仃 elephone): (Fax): (Mobile Phone):制造商相关信息(Information of the Manufacturer) 同申请人(same as applicant )制造商名称仲文)：Name ofManu facturer(Ch in ese):制造商名称(英文)：Name ofManu facturer(E nglish)制造商地址仲文):Address ofManu facturer(Chi nese)制造商地址(央文):Address ofManu facturer(E nglish)制造商组织机构代码：邮政编码：Post Code :国家或地区：所在

4、省市：联系人仲文)：Pers on to be con tacted:联系人(English):Pers on to be con tacted :E-mail : 仃 elephone): (Fax): (Mobile Phone):生产厂相关信息(1 nformation of the Factory)冋申请人(same as applicant )冋制造商(same as applicant )生产厂名称仲文)：Name of Factory(Ch in ese) :生产厂名称(英文)：Name of Factory(E nglish)生产厂地址仲文)：Address(Chinese):

5、生产厂地址(英文)：Address(English):生产厂组织机构代码：CCC工厂编号：国家或地区：所在省市：邮政编码：Post Code :联系人仲文)：Pers on to be con tacted:联系人(English):Pers on to be con tacted :E-mail : 仃 elephone): (Fax): (Mobile Phone):申请认证产品相关信息(In formati on of the Producti on)产品名称(中文)：Name of Productio n( Chi nese):产品名称(英文)：Nameof Productio n(E

6、n glish):型号规格(中文)：Model a ndSpecificatio n(Chin ese) 型号规格(英文):Model a ndSpecificati on( Eglish)商标(中文):Trade Mark(Chi nese) 商标(English):Trade Mark(E nglish)产品类别:Product Sort :备注/其它需要说明的情况(Note):1、申请认证产品的 GB 标准号 /GB standard for the equipment to be certified1.1、平安标准Sta ndard for Safety1.2、EMC 标准Standa

7、rd for EMC(如有/If applicable):2、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:获证日期/Issued Date:c.颁发 CB 测试证书的认证机构名称/Name of the NCB issuing the CB Test Certificate3、 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 thefactory has ever obta ined CCC or CCEE or C