s-jet-pr51-02e-ed1.0
(Form 1)
Application for JET Certification
Date: Receipt No.
(To be filled in by JET)
To Japan Electrical Safety & Environment Technology Laboratories
We hereby apply for Certification on the Product listed below, in order to obtain the Certification thereon as specified in the Rules for Operation of JET Certification.
１．Applicant Company name: Address:
２．Product name ３．Model: (attach another sheet if necessary.) ４．Factory: (As shown in the attachment) ５．Applied Standard for Testing: (Tick off the appropriate box below with a cross.) □ METI Ordinance Article 1( □ METI Ordinance Article 2( □ Standard other than METI Ordinance ( ６．Application: (Tick off the appropriate box below with a cross.) □ New application □ Additional application (Certificate No. ７．Responsibility to this application Company name Address
) ) )
)
Title & Position Name (Signature or seal) TEL: FAX: E-mail:
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S-JET-RE-101-1/2 Receipt No.
(To be filled in by JET)
Annex of Application form (Form 1)
1. Is this your first application? (Tick off the appropriate box below with a cross.) □ Yes □ No ( Show the latest certificate no. issued by JET below.) (JET ) Show the name and title of the representative of an applicant (ex. Mr. James Wagner, president & CEO)
2.
3.
An applicant is obliged to submit following documents to JET on each application.
(Tick off the appropriate box below with a cross.)
□ List of factory(s) (S-JET-RE-002) □ Declaration of Technical Specifications (S-JET-RE-003) □ Confirmation sheet for the addressee (S-JET-RE-004) 4. An applicant is obliged to submit following documents to JET when necessary. □ Power of Attorney (S-JET-RE-005: A power of attorney is required, when an agent makes an application.) □ Application form for testing at manufacturer’s premises (S-JET-RE-006 : when an applicant requests JET to test products at manufacturer’s premises) □ CB certificate (if an applicant requires the use of data produced based on CB scheme.) Issue of Test Report (Tick off the appropriate box below with a cross.) □ Yes ( Japanese / English version ) (fee-charging) □ No Request of quick issuance of the Certificate (fee-charging) □ Yes (mo. day, year ) □ No
(Tick off the appropriate box below with a cross.)
5.
6.
7.
Information on test sample (Show shipping schedule, number of carton and other necessary information below.) □ Schedule of shipping only test sample to JET (approximate shipping schedule : mo. day, year) □ Schedule of carrying in test sample(s) directly to JET (approximate schedule of carrying
sample(s) directly to JET : mo. day, year)
in test
□ Schedule of shipping application documents and test samples packaged in the same carton(s) to JET ( approximate shipping schedule : mo. day, year ) *Details:
8.
Describe request or information concerned below, if any.
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S-JET-RE-101-2/2
Confirmation Sheet
In applying for Certification, I (responsibility to this application) agree to the following: □ The applicant consents to the below. (Tick off the box with a cross, if agreeable)
(Signature)
１．This application will be completed after JET's receipt of the Test sample, necessary documents and estimate costs for Certification. ２．If the Test sample and necessary documents are not received within six months after the date when JET verifies its receipt of this Application, this Application will be deemed to have been withdrawn at the Applicant's request. ３．The Test sample shall be delivered to and received by, Japan Electrical Safety & Environment Technology Laboratories (Tokyo Lab., Yokohama Lab or Kansai Lab.) in the risk and responsibility of the Applicant. ４．The applicant shall immediately take a countermeasure to the Test sample, when JET informs the applicant of a defect or damage found in the Test sample delivered to JET. ５．JET will not be responsible for any disassembly or damage of the Test sample(s) which may have arisen as a result of testing. ６．The Applicant may reclaim the Test sample to which Test has been conducted within 50 days after completion of testing. If the sample is not reclaimed within that period, JET may freely dispose of it. The Applicant shall bear all expenses related to reclaiming or JET disposal of the Test sample. ７．The Applicant agrees to allow JET employees to enter and perform necessary investigations in the Manufacturing factories when requested for the conduction of the Preliminary Factory Inspection. ８．All clauses specified in the "Rules for Operation of JET Certification" are applied for this Application.
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S-JET-RE-102 Receipt No.
(To be filled in by JET)
List of Factory(s)
1. Is this your first application? (Tick off the appropriate box below with a cross.) □ Yes (Proceed to ｢2｣.) □ No (An applicant has already obtained the certificate issued by JET.) □ The factory making application this time is the same factory shown in the certificate issued by JET. (You are requested to only fill in the number of certificate.) (JET ) □ The factory making application this time is different from the factory shown in the certificate issued by JET. (Proceed to ｢2｣.) 2. Describe all of the factory(s) making application both in English and Chinese, if the factory(s) is(are) located in China or Taiwan.
(Describe factory(s) concerned in the annex, if the number of factory is more than 4.)
Factory 1 Name of factory: Address of factory:
Factory 2 Name of factory: Address of factory:
Factory 3 Name of factory: Address of factory:
Factory 4 Name of factory: Address of factory:
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S-JET-RE-103 Receipt No.
(To be filled in by JET)
Declaration of Technical Specification
１．Product name:
２．Model and its rating: (Rated voltage, rated frequency, rated power consumption, etc.)
３．Technical information:
(Please describe or attach necessary information to show photo, casing materials, components listings, circuit diagrams, marking, owner's manuals, and other information needed to conduct the tests.)
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S-JET-RE-104 Receipt No.
(To be filled in by JET)
Confirmation Sheet of Addressee
Following are contact persons for this application. (Tick off the appropriate box with a cross.) １．Reference from JET ; □ Responsible person for the application □ Reference No. 1 below □ Reference No. 2 below ２．Addressee of Certificate and Test Report ; □ Responsible person for the application □ Reference No. 1 below □ Reference No. 2 below ３．Addressee of bill for testing fee and others ; □ Responsible person for the application □ Reference No. 1 below □ Reference No. 2 below
(You are requested to attach the note of an addressee, if the addressee is different from the name of an applicant.)
４．Return of tested sample(s) ; □ In the case of delivery charge collect (Tick off the appropriate box with a cross.) □ Responsible person for the application □ Reference No. 1 below □ Reference No. 2 below □ The applicant receives tested sample(s). □ The applicant requires JET to destroy tested sample(s) at JET (However it is limited to small sized sample(s). The applicant is obliged to bear expenses for destruction of tested sample(s).)
Where to make contact: Reference No. 1 Name of company: Address: Name of person in charge: Title: Tel : Fax : Where to make contact: Reference No. 2 Name of company: Address: Name of person in charge: Title: Tel : Fax :
E-mail :
E-mail :
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S-JET-RE-105 Receipt No.
(To be filled in by JET)
Power of Attorney
( mo. ) ( day ), ( year )
Messrs. Japan Electrical Safety & Environment Technology Laboratories
I hereby entrust the following person as agent of the applicant with full power for the application, the change in certification, etc. for JET certification.
[Agent]
_________________ Entrusted Person (Name) Title & Position: Name of Company: Address: Tel: Fax :
[Effective Period of Entrustment] (Tick off the appropriate box with a cross.) □ Till change of agent □ From to [(mo.) (day),(year)]
[Applicant]
___________________ Applicant: (Name) (Describe the applicant of “Application for JET Certification”.) Title & Position: Name of Company: Address: Tel: Fax:
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S-JET-RE-106 Receipt No.
(To be filled in by JET)
Application for Testing based on Procedures of Testing at Manufacturer’s Premises
To Japan Electrical Safety and Environment Technology Laboratories
I hereby apply for testing products stated hereunder at the manufacturer’s premises.
１．Applicant for Certification: Address: Company :
２．Electrical Appliance :
３．Product Model: (All of models shall be written here. Attached sheets might be used in the case of many models.)
４．Reason of Application:
５．Place for Testing :