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Swim seats to be worn - Dolomiticert

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									                DOLOMITICERT



                               FORMAT FOR DATA COLLECTION

In connection with the request of the company _________________________, headquartered in
________________________________________, for a quote related to the issue of the EC Type
Examination of the device ______________ named ________________, the following information
has to be filled in.


Type of device:                             Swim seats to be worn
Reference Standard:                         EN 13138-3
Device name/code:
                                               A;
Device class:                                  B;
                                               C.
                                               Inherent (that is consistent and continuous material,
                                               for example foam);
Type of buoyant material:                       Air (by means of inflatable chambers);
                                               Filling material (for example by means of granules,
                                               air sacs, etc…).
                   User weight:
Sizes:
                   User age:
Pictures of the device:
SHORT DESCRIPTION OF THE
DEVICE:
 - Materials;
 - If there are load bearing thread;
 - Material of the load bearing thread;
 - If there are buckles or other fixings;
 - If there is zippers;
 - Number of chambers (if the device is
   inflatable or with filling material);
 - If there are small parts which may
   become detached from the device;
 - If    there are special features or
   equipment;
 - Dimensions;
 - Any other information useful to
   describe the device.
Variations:
Short description of the variations:

                                                                    M.108.2.002.41_ENG - Rev. 2 del 27/06/2012
              DOLOMITICERT


Copy of the marking, labelling and
information   supplied  by     the To send with the test samples
manufacturer.
Protection clothing just certified (specify
CE number and type of examination).


Date: ______________                                                    The responsible
                                                                    ____________________




                                                              M.108.2.002.41_ENG - Rev. 2 del 27/06/2012

								
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