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					Reference: AF01-011000
                                                                                                                                                   Application Form
                                                                                                                                               Television Sets
To register your model(s) please send this registration form to one of the National Registration Offices of the GEEA. Data in grey areas is mandatory.
Scope, criteria and test method are described in the document: CE01-011000 (Product Sheet Television Sets). The verification procedure is described in IEC 62087:2002 (Annex
A). For information on how to obtain IEC 62087:2002 please contact the GEEA Secretariat at kimj@ramboll.dk.


                                                            Model 1                                                       Model 2                                                Model 3                                                    Model 4                                                      Model 5




                                                                                                                                                                                                                                                                                                                                                                                        Group for Energy Efficient Appliances
 Trademark/Brand

 Model description
          standby
                                                                                                             [W]                                                           [W]                                                 [W]                                                          [W]                                                          [W]
          passive
 Power
          standby
 consump-                                                                                                    [W]                                                           [W]                                                 [W]                                                          [W]                                                          [W]
          active*
 tion
          on                                                                                                 [W]                                                           [W]                                                 [W]                                                          [W]                                                          [W]
                                                                                                         [cm]                                                          [cm]                                                 [cm]                                                        [cm]                                                          [cm]
 Screen diagonal
                                                                                                       [inch]                                                        [inch]                                               [inch]                                                      [inch]                                                        [inch]

 Format 16:9 (widescreen)                                         Yes                            No                           Yes                            No                 Yes                            No                           Yes                           No                          Yes                             No 

 Scan rate                                                     50 Hz                       100 Hz                          50 Hz                       100 Hz                 50 Hz                       100 Hz                         50 Hz                      100 Hz                          50 Hz                       100 Hz 

Market introduction                                                                                  [mm.yy]                                                       [mm.yy]                                              [mm.yy]                                                     [mm.yy]                                                       [mm.yy]

                                                             A CH D DK F FIN NL SE A CH D DK F FIN NL SE A CH D DK F FIN NL SE A CH D DK F FIN NL SE A CH D DK F FIN NL SE
Available in (tick country code(s)):
                                                                                                    

* If applicable for the model
We confirm that:
   the information on the registration list above is correct;
   the company has signed the Industry Self-Commitment to Improve the Energy Performance of Household Consumer Electronic Products Sold in the EU (1st July 2003)
   we accept the conditions of the document General Rules (reference document AG01-220399);
   we are entitled to register the models on the list above.

Company:         .......................................................................................................................................................    MsMr:                              ...................................................................................................................................................................


Address:         .......................................................................................................................................................    Venue & Date:                        ...................................................................................................................................................................


Telephone:       ..................................................        Telefax:                 ..................................................         E-Mail:           ...........................................................................       Signature:                         ...............................................................................


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Group for Energy Efficient Appliances                                                                                                                                                                                                                                                                                                                     www.efficient-appliances.org

				
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