Manufacturer Declaration of
Conformity
‫ﻧﻣﻭﺫﺝ ﺍﻟﺗﻌﻬﺩ ﻭﺍﻹﻗﺭﺍﺭ ﻣﻥ ﻗﺑﻝ ﺍﻟ ُﻣﺻﻧﻊ‬
A. Unique identification No of the electrical equipment under application
BRAND NAME
Reference Standard
(SASO-IEC…)
MARKETING NAME
MODEL NO.
B. Manufacturer Details
Name of the Manufacturer:
Address of the Manufacturer:
Contact Person:
Email address:
Telephone / Fax no.:
Mobile phone no.:
C. Details of Authorized Representative / Importer in KSA
Name of Authorized Representative:
Address of Authorized Representative:
Commercial License No.:
D. Additional information
This is a self-declaration of compliance to National and/or International approved Standards and the applicable
Technical Regulation in the Kingdom of Saudi Arabia issued under the sole responsibility of the manufacturer
Signed for and on behalf of:
(Company Name):
(place and date of issue):
(Authorized Person Name and
Designation):
(signature):
(Company Stamp):
This form is to be printed on the Applicant's (Manufacturer) letterhead
CER-IE-F-02.v.1.0