APPLICATION FORM FOR SYSTEM 1 CONSTANCY OF PERFORMANCE

FOR UKCA AND/OR “CE+UK(NI)” CONSTRUCTION PRODUCTS

MIRROR CERTIFICATION

All fields are mandatory except the blue field. Incomplete forms will be returned to the applicant and must be revised before the application can be progressed further.

SPECIFY THE APPLICATION TYPE

New application UKCA: Has the product been previously CE Marked by Warringtonfire? If so, please provide the CE Marking Certificate Number New application “CE+UK(NI)”: *if you already have CE marking then you cannot apply for “CE+UK(NI)” for the same product	Modification to existing certificate: Renewal: Existing certificate number:

2. Company to hold mirror certification:
2.1) Address:	2.2) Telephone Number:
2.3) Main e-mail address:
Contact Name(s): E-mail: Position:	2.4)	2.5)
2.6) Number of employees involved in the distribution process _____

3. Original certificate holder:
3.1) Address:	3.2) Telephone Number:
3.3) Main e-mail address:
Contact Name(s): E-mail: Position:	3.4)	3.5)

4. Please confirm the invoicing address for this certification: (tick as appropriate) a) 2.1 ☐ b) 3.1 ☐ (Of those detailed above) c) Other _____________________________________________________________ (Please specify)
5. Contact for this application to be made with: (tick as appropriate) a) 2.4 ☐ b) 2.5 ☐ c) 3.4 ☐ d) 3.5 ☐ (Of those detailed above)

6. Mirror Certificate Details A Mirror Declaration form is required for each manufacturing site
Original Certificate Number	Original Product Name	Mirror Brand Name	Description of product for which certification is to be granted (product type and application)	Name and Address of Product Manufacturing Site(s)	Manufacturer(s) contact details (name, email, telephone)	Product Standard ETAG/EAD

7. Please list any additional sites involved in the distribution or modification of the product and provide details of the process followed for each site.
Original Certificate Number	Type:	Name and Address	Details
Warehouse ☐ Manufacturing site ☐
Warehouse ☐ Manufacturing site ☐
Warehouse ☐ Manufacturing site ☐
8. Quality Systems Certification Body: Reference Number:

Please complete the certification agreement on page 3 and return the completed application form along with any supporting documentation to WFS@warringtonfire.com

9. Certification Agreement

Applicant

We hereby apply for Warringtonfire Testing and Certification Limited Attestation of Conformity certification/extension of existing certification for the above-mentioned product(s).

We understand that the application will be evaluated against the requirements of the technical specifications for UKCA and/or “CE+UK(NI)”.

We shall ensure that Construction Product regulations are met, with the provision of a compliant Declaration of Performance document for each product. We confirm this document shall be available to the customer / end user upon receipt of Certification.

We confirm that the certified product detailed above will not be changed in any way that may affect the products performance.

We will not claim any properties for the product which exceed those already stated within the existing Certificate of Conformity certificate.

We shall ensure full product traceability is maintained to the manufacturer’s batch records when making any change to product packaging or labelling and that all product labelling, installation, and maintenance instructions are produced, fitted, and made available to the customer.

We are aware that this application is subject to the completion of successful quality audit(s).

In the event of certification being granted we undertake to conform to the relevant product standard(s) including audit testing and factory production control auditing.

For details of Warringtonfire Testing and Certification Limited accreditation and locations of approval please refer to the quality section of our website (www.warringtonfire.com).

Do you agree to share all relating documentation with the original certificate holder, including audit reports?	YES / NO (Please circle / highlight as appropriate)

Please confirm that you have supplied the following documents with this application (if applicable):

Supplied	To be Sent with PO or payment
Mirror Declaration form (EWC-QU-FT-468)
Copy of the contract between mirror applicant and original certificate holder, as detailed in guidance document EWC-QU-GD-002
Draft example of product and packaging label
Draft example of product installation instructions
Confirm you will have a Declaration of Performance (DOP) in place

If all the above documents are supplied along with your application, no mirror certificate audit will be required. If the documents are not supplied with the purchase order or payment, then we will requote to include a mirror certificate audit.

Please tick this box if you already have UKCA and/or “CE+UK(NI)” certification from another approved body for this product Please advise who the approved body is that you already have UKCA and/or “CE+UK(NI)” certification with (if applicable): Please tick this box to confirm that you do not already hold certification for this product with another approved body: If selected, the certification must be withdrawn before we can process this application

Authorised signatory of the mirror applicant:	Position:
Print Name:	Date:

Original certificate holder

We give our permission for the above company to use our FPC and sampled test evidence in support of this application.

Authorised signatory of the above original certificate holder:	Position:
Print Name:	Date:
For internal use only: