to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
Applicant
Company name:
Contact person:
Address:
Postal code + town:
Telephone number:
E-mail:
VAT number:
Location of the pressure equipment to be inspected
Company name:
Contact person:
Address:
Postal code + town:
User (when not the applicant)
Company name:
Contact person:
Address:
Postal code + town:
Telephone number:
E-mail:
Debtor (in case not the applicant)
Company name:
Contact person:
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 1of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
Address:
Postal code + town:
Telephone number:
E-mail:
VAT number:
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 2of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
The “Keuring Voor Ingebruikname” concerns (please check the appropriate box):
Statutory inspection based on WBDA article 12b, or
Inspection on second party request
And is applicable for the following situation (please check the appropriate box):
A. Temporary use of rental boiler
B. Replacement of statutory pressure equipment
C. Displacement of statutory pressure equipment
D. Pressure equipment with an “entrance” certificate (WBDA art. 12d)
E. Modification of an existing installation
Modification concerns:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
F. CE marked Assembly ( EC-Declaration of Conformity)
G. Pressure System with a VvO (Verklaring van Overeenstemming)
In case none of the above mentioned situations is applicable then probably there should first be an assessment of a Pressure
System or Assembly. Please check the relevant application forms on our web-site.
In case of questions please contact our Customer Service Department (+31 10 2014217).
Based on above chosen situation, the applicant requests (please check the appropriate box):
an appointment with the surveyor in order to review the documents and to advise for the coming KVI
inspection.
telephone contact with a Customer Service employee for information on the activities.
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 3of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
an appointment for carrying out the KVI inspection. All required documentation has been attached to the
application or is available on site as mentioned in the summary on the following page.
NB: In case of above mentioned options E, F and G an assessment of the documents is required, either at
the Lloyd’s Register office or at your location, before the KVI inspection can take place.
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 4of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
The following information has been provided with the application (1) or is available during the KVI (2)
(please check the applicable column for the enclosed or available information)
concerns (see previous page)
→
1
Verklaring van Ingebruikneming (VVI) (note-a), Note sheet,
re-inspection certificate of the rental boiler.
2
Verklaring van Ingebruikneming (VVI)( note-a), note sheet and
re-inspection certificate of the pressure vessel.
3
DOC or VVO note-b of the pressure vessel(s).
4
User manual of the pressure equipment (applies to pressure
equipment with CE marking)
5
EC-DoC and user manual of the Assembly
6
Document of Conformity and user manual of the Pressure
System
A
B
C
D
E
F
G
(2)
(2)
(2)
(2)
(2)
(2)
(2)
(2)
(2)
(2)
(2)
(2)
(1)
7
Process description
8
Process diagram (e.g. P&ID)
9
Classification list note-c (in case of multiple pressure equipment)
with data concerning process, design and classification.
10
Entrance Certificate (draft) (note-d).
11
When applicable:
Data of safety valves and instrumental safeguarding (note-e).
(1)
(1)
(1)
(1)
(2)
(2)
(2)
(1)
(1)
(1)
(2)
(2)
(2)
(1)
(1)
(1)
(1)
(1)
(1)
(1)
(2)
(2)
(2)
(1) Please enclose information with application form; this is required to process your request.
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 5of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
(2) Document / information should be present during the KVI.
Note:
a. Licence and Letter of No Objection is equal to the “VVI” (note: VVI is a Licence to Operate)
b. The following depends on the year of fabrication:
- Certificate of Investigation and Testing or,
- Certificate of Manufacturing and First Pressure test or,
- EC-Declaration of Conformity.
c. The maximum safeguarded pressure and temperature applicable for the installation must be integrated in
the classification list. The KVI is based upon those requirements (see example in Praktijkregels
Drukapparatuur, part 2.1).
d. Certificate of Entrance applies to equipment manufactured before May 2002 and imported from another
member state and used in The Netherlands.
e. EC-Declaration of Conformity, user manual and data on the adjustment and calculated and installed
capacity (for safety valves e.g. an adjustment certificate issued by a certified reconditioning T0103
company).
* For additional information on the required data for your specific application an appointment with our surveyor is
possible in order to discuss the KVI and to review the documents.
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 6of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
Pressure equipment data
Description of the pressure vessel:
If known:
 Registration no. of pressure vessel / rental boiler:
Manufacturing / serial no.:
Registration no. of EC Declaration of Conformity:
Item number:
Volume /Capacity of the vessel in liters:
Nominal diameter of the pipeline / appurtenance (DN) in mm:
Heated surface (boilers / economisers) in m2:
Safeguarding and use according to norm/code (boilers):
Max/min design pressure PS(barg) and Max/min design temperature TS in °C:
Safeguarded pressure PSi (barg) and Safeguarded temperature TSi in °C:
Fluids:
Phase of the fluids at TSi: (Gas(G), liquid Gas (G), Gas (G) dissolved under pressure,
vapour (G), Liquid (L)
Fluid Group, according to PED, art 9**
1
2
Applied table according to PED, art. 3 – paragraph 1 / PED, appendix II **
* Category according to PED, appendix 2 **, @ PSi /TSi
* Applied table according to Warenwetregeling drukapparatuur article 2 **, @ PSi /TSi
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 7of 8
to be filled in by LR-Netherlands
File number:…………………
Order number:………………
Application Form for a
Keuring Voor
Ingebruikneming (“KVI”)
Warenwetbesluit Drukapparatuur (WBDA)
Remarks:
In case the application applies to multiple vessels, it is sufficient to refer to a classification list or a specific
data overview.
** For the determination of the fluid group, table, category and the inspection obligation you can use the
Software tool “PED Calculator”, free available on our website (www.stoomwezen.nl).
The filled in form with attachments can be forwarded to:

By e-mail: sales-e&[email protected]

By regular mail: Lloyd's Register Nederland B.V.
F.a.o. Energy Customer Service Department
PO Box 701, 3000 AS Rotterdam
Lloyd’s Register Nederland B.V. is a subsidiary of Lloyd's Register EMEA. Lloyd’s Register EMEA (Reg. no. 29592 R) is an Industrial and Provident
Society registered in England and Wales. Registered office: 71 Fenchurch Street, London, EC3M 4BS, UK. A subsidiary of the Lloyd’s Register Group
Limited. Lloyd’s Register, its affiliates and subsidiaries and their respective officers, employees or agents are, individually and collectively, referred to in
this clause as the ‘Lloyd’s Register Group’. The Lloyd’s Register Group assumes no responsibility and shall not be liable to any person for any loss,
damage or expense caused by reliance on the information or advice in this document or howsoever provided, unless that person has signed a contract
with the relevant Lloyd’s Register Group entity for the provision of this information or advice and in that case any responsibility or liability is exclusively
on the terms and conditions set out in that contract.
Form 2014.1
Page 8of 8