Doc. Ref: EWC-QU-FT-69
(Issue 3 – 04/04/2017)
Page 1 of 5
Notified Body No: 1121
PRODUCT CERTIFICATION MARINE EQUIPMENT DIRECTIVE
– REQUEST FORM
From here on in, references to Exova (UK) Limited trading as Warrington Certification will be shown as
Warrington Certification.
We request Warrington Certification to carry out the conformity assessment for the under mentioned equipment
for Product Certification
1.
SPECIFY THE APPLICATION TYPE
New application:

Amendment to existing application:

If yes, please specify the ID or job number:
2.
APPLICANTS NAMES & NORMAL BUSINESS ADDRESS
Name:
NOTES
Address:
Enter office name & address
for routine correspondence
and nominate a contact
familiar with your request for
EC Product Certification
Postcode:
Nominated Contact:
Tel No:
Fax No:
E-mail address:
3.
PRODUCER’S NAME & NORMAL BUSINESS ADDRESS
Name:
NOTES
Address:
Enter details ONLY if they are
different to those entered in
section 1.
Postcode:
Nominated Contact:
Tel No:
Fax No:
E-mail address:
4.
EUROPEAN BUSINESS ADDRESS
NOTES
Name:
Enter details of the agent or
person with responsibility for
the product in Europe unless
this is also the address of the
Applicant
Address:
Postcode:
Nominated Contact:
Tel No:
Fax No:
E-mail address:
Exova (UK) Limited trading as Warrington Certification
Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom. Co. Reg. No.
SC070429
Doc. Ref: EWC-QU-FT-69
(Issue 3 – 04/04/2017)
Page 2 of 5
Notified Body No: 1121
5.
PLACE OF PRODUCTION
Name: To be determined – facilities will be “modular” and portable
NOTES
Address:
Enter details of the production
facility where the product is
manufactured. If more than 1
factory is involved please
provide additional addresses.
Postcode:
Nominated Contact:
Tel No:
The nominated contact is
required to facilitate making
arrangements to visit the
facility.
Fax No:
E-mail address:
6.
TYPE OF REQUEST
New EC Certificate

Extension of EC Certificate
Renewal of EC Certificate
NOTES

Please tick  the appropriate
box

If an extension, please state previous Certificate Number:
7.
PRODUCT ACCOUNTABILITY
(Only complete this section if the details in sections
1 & 2 are different)
What is your relationship with the producer?
NOTES
Please provide details in this
section if you completed both
section 1 and section 2 of the
form.
Do you alter the product before marketing?
Yes

No

If ‘Yes’ please specify:
Where there is a bi-lateral
agreement, e.g. licensee,
include a statement from the
producer confirming the
agreement.
Include changes to the label or
type designation, in addition to
details of any design changes.
What procedures are followed to verify conformity of the product to design
specifications?
This also refers to:
- incoming goods from
producer
- ensuring conformity during
production. e.g. ISO 9000
series, own quality system etc.
Exova (UK) Limited trading as Warrington Certification
Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom. Co. Reg. No.
SC070429
Doc. Ref: EWC-QU-FT-69
(Issue 3 – 04/04/2017)
Page 3 of 5
Notified Body No: 1121
8.
DESCRIPTION OF PRODUCT
a)
Abbreviated version:
NOTES
This description will form the
basis of that which will appear
on your Certificate.
The detailed description
should precisely identify the
equipment (product) and will
be used as the basis for the
schedule to the certificate.
b)
Detailed description
9.
NORMAL TYPE DESIGNATION
Reference No:
Is this a general code for a range of products?
NOTES
Yes

No

See Annex A. 1/3 of the
Marine Equipment Directive
If ‘Yes’, state whether the entire range OR which individual items from the
range are to be approved: Individual products. One is currently available.
Another will be available in 2 months.
Is this a range of products? Please provide details of the range.
Colour?
Thickness?
Density?
Other?
10.
DESIGN PERFORMANCE STANDARDS, CODES AND RULES
Please state the standards that the product is to be certified as complying
with:
i.e.
IMO Resolution MSC 307 (88) Annex 1 Part 11 (fire-resisting divisions of high speed craft test)










Not Known

IMO Resolution MSC 307 (88) Annex 1 Part 1 (non combustibility test)
IMO Resolution MSC 307 (88) Annex 1 Part 2 (Smoke and toxicity test)
IMO Resolution MSC 307 (88) Annex 1 Part 3 (fire resistance of A, B and C class divisions)
IMO Resolution MSC 307 (88) Annex 1 Part 4 (Test for fire door control systems)
IMO Resolution MSC 307 (88) Annex 1 Part 5 (Surface Flammability test)
IMO Resolution MSC 307 (88) Annex 1 Part 7 (vertically supported textile and films test)
IMO Resolution MSC 307 (88) Annex 1 Part 8 (upholstered furniture test)
IMO Resolution MSC 307 (88) Annex 1 Part 9 (Bedding components test)
IMO Resolution MSC 307 (88) Annex 1 Part 10 (fire-restricting materials for high speed craft test)
Notes
This may include the producer’s
own specifications i.e. FPC
tests, provided a copy is
submitted with this request.
This must include however, the
required IMO Test Specification
as given in the Fire Test
Procedures Code.
Exova (UK) Limited trading as Warrington Certification
Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom. Co. Reg. No.
SC070429
Doc. Ref: EWC-QU-FT-69
(Issue 3 – 04/04/2017)
Page 4 of 5
Notified Body No: 1121
11.
DOCUMENT CHECK LIST
A general description of the product.

Design drawings, catalogue, data sheet sufficient to fully define the
product (as appropriate)

Schemes of components, sub assemblies etc. (as appropriate)

Functional description.

Full Description.

NOTES
Please tick ‘’ to indicate that
the required information has
been provided.
Provide one set of relevant &
comprehensive documentation,
which will be retained by
Warrington Certification.
Confirm that the appropriate
information has been provided.
As appropriate – please include if necessary:Technical construction file.

Existing test reports.

Relevant existing certificates.

Description of changes since previous Approval (see section 4)

Statement from producer (see section 5)

12.
NOTES
Please tick ‘’ to indicate which
appropriate documentation has
also been provided.
DECLARATION
We declare that the information given in this form is accurate and complete and that a Conformity
Assessment is request for Marine Equipment detailed herein.
We confirm that the same application has not been lodged with any other notified body.
We agree to give Warrington Certification or their representative every facility and necessary access to
carry out their duties and agree to pay the fees and expenses incurred for any services provided resulting
from this request.
In the event of the Conformity assessment not being completed we understand that charges will be made
at a rate pro-rata for services rendered.
This request is made upon the following terms:
Product Certification is based on the understanding of compliance with the manufacturer’s
recommendations and instructions and any relevant requirements of the Directive(s).
Warrington Certification will execute the Product Certification in accordance with the procedure set out in
Warrington Certification Guidance Notes for AoC for Marine Equipment Directive.
Product Certification certifies that a representative sample of the product(s) referred to herein has/have
found to meet the applicable criteria for the Directive(s) specified herein. It does not mean or imply
approval for any other use, nor for any products(s) designed and manufactured otherwise than in strict
conformity with the said representative sample. It is understood that Warrington Certification will not
conduct specific checks relating to computer software or hardware.
Warrington Certification reserves the right to cancel or withdraw Product Certification.
Exova (UK) Limited trading as Warrington Certification
Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom. Co. Reg. No.
SC070429
Doc. Ref: EWC-QU-FT-69
(Issue 3 – 04/04/2017)
Page 5 of 5
Notified Body No: 1121
In providing services, information or advice, neither Warrington Certification nor any of its officers,
employees or agents warrants the accuracy of any information or advice supplied. Except as set out
herein, neither Warrington Certification nor any of its officers, employees or agents (on behalf of
Warrington Certification has agreed this clause) shall be liable for any loss, damage or expense whatever
sustained by any person due to any act, omission or error of whatsoever nature and howsoever cause of
Warrington Certification its officers, employees or agents or due to any inaccuracy of whatsoever nature,
howsoever caused in any information or advise given in any way whatsoever b or on behalf of Warrington
Certification, even if held to amount to a breach of warranty. Nevertheless, if any person , who is party to
the agreement pursuant to which Warrington Certification provides any service, uses Warrington
Certification services or relies on any information or advise given by or on behalf of Warrington
Certification and suffers loss, damage or expense thereby which is probed to have been due to any
negligent act, omission or error, Warrington Certification, its officers, employees or agents or any negligent
inaccuracy of information or advise given by or on behalf of Warrington Certification, then Warrington
Certification will pay compensation to such person for his proved loss, up to, but not exceeding the amount
of the fee (if any) charged by Warrington Certification for that particular service, information or advice. Any
dispute concerning the provision of Warrington Certification services under this contract is subject to the
exclusive jurisdiction of the English Courts and will be governed by English Law.
Warrington Certification its officers, employees or agents (on behalf of whom this notice is given) shall be
under no liability or responsibility negligence or otherwise howsoever to any person who is not a party to
the agreement with Warrington Certification in respect of any information or advice implied or expressly
given by Warrington Certification or in respect of any act, omission or inaccuracy by Warringtonfire.
Signature:
Date:
Name (in BLOCK CAPITALS):
Our reference:
Position in Company:
Exova (UK) Limited trading as Warrington Certification
Reg. Office: Exova (UK) Limited, Lochend Industrial Estate, Newbridge, Midlothian EH28 8PL United Kingdom. Co. Reg. No.
SC070429