ANNEX IV
EU DECLARATION OF CONFORMITY (No XXXX) (1)
1. | No ... (product, type, batch or serial number): |
2. | Name and address of the manufacturer and, where applicable, his authorised representative: |
3. | This declaration of conformity is issued under the sole responsibility of the manufacturer. |
4. | Object of the declaration (identification of product allowing traceability): |
5. | The object of the declaration described above is in conformity with the relevant Union harmonisation legislation: |
6. | References to the relevant harmonised standards used or references to the other technical specifications in relation to which conformity is declared: |
7. | The notified body ... (name, number) performed ... (description of intervention) and issued the certificate: |
8. | Additional information: Signed for and on behalf of: (place and date of issue): (name, function) (signature): |
(1) It is optional for the manufacturer to assign a number to the declaration of conformity.