Old certificate no.:
Manufacturer:
The product(s) and types, as well as the production sites correspond to the entries in the test certificates or certificates specified above.
The manufacturer declares:
1.	The present product continues to be manufactured at the production facility(ies) indi-cated within the scope of the last testing.
2.	The quality standard found and documented during the last inspection of the production facility(ies) on: the technical equipment and personnel resources the manufacturing processes, the qualified incoming goods control and production control, such as intermediate and final product control and the particular product-specific requirements continues to comply with the quality standard found on the last inspection of the production facility(ies) concerned.
3.	The present product, including the tested variants, components and optional equipment, corresponds in all aspects to the type presented within the scope of the last testing.
4.	No complaints, e.g. from customers or authorities, concerning safety-related aspects of the product have been reported since the last testing.

☐ There are deviations from this declaration. In that case, deviations must imperatively be

attached as a written annex with reference to this application.

Remarks:

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Place, date	Signature (manufacturer)