FORM FOR THE APPLICATION TO ISSUE
A EUROPEAN TECHNICAL ASSESSMENT
UNDER ARTICLE 26 OF REGULATION (EU) No. 305/2011
1. The application is made to:
Kiwa Nederland B.V., Sir Winston Churchillaan 273, Postbus 70, 2280 AB Rijswijk, Netherlands
als vertegenwoordiger van: Stichting NL-TAB, Postbus 1201, 2280 CE, RIJSWIJK, Netherlands,
2. Applicant:
a) Manufacturer1 (Name and address):
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b) Or a an authorised representative (based in the European Union):
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according to the attached written mandate, dated: Click here to enter text.
3. ETA holder (if different from the applicant):
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4. Type of construction product:
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5. Trade name(s) of the product, which shall be included in the European Technical
Assessment:
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6. Description of the construction product, the intended use or the intended uses and the
essential characteristics of the product:
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7. Assessment of essential characteristics of the product with methods and criteria used in
other harmonised technical specification(s) 2
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1. The product is covered by EAD No: Click here to enter text.
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2. The product is covered by ETAG3 No: Click here to enter text.
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3. The product is partially covered by an harmonized standard (hEN) No: Click here to enter text.
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4. The product is partially covered by EAD No: Click here to enter text.
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5. For the construction product there are no applicable harmonised methods and criteria for
assessing the performances of the product under an hEN, an EAD or an ETAG.
1
According to Article 2(19) of the Regulation the 'manufacturer' means any natural or legal person who
manufactures a construction product or who has such a product designed or manufactured, and markets that
product under his name or trademark. An Assessment is generally issued for one applicant each.
2 Mark with a cross where applicable
3 Used as an EAD according to Art. 66 (3) of the Regulation (EU) No. 305/2011)
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Form sheet application ETA according to CPR version 29-10-2013
8. Documents required for application
In cases 1 and 2 of Section 7.:
Additional techncial documentation shall be presented to allow a judgement that the said EAD or the
said ETAG can be applied in full.
In cases 3, 4 and 5 of Section 7.:
For a complete application a technical file shall by all means be submitted by the manufacturer 2.
☐The technical file, dated Click here to enter text., is enclosed.
☐The technical file is expected to be submitted to Kiwa by Click here to enter text.
9. Manufacturing plant(s)4:
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10. Declaration of the applicant
I hereby declare that2
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I have not filed an application for a European Technical Assessment for the construction
product with any other Technical Assessment Body;
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I have filed an application with
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(Name of the Technical Assessment Body)
That request was rejected/withdrawn, because Click here to enter text.
Furthermore, I declare that
 I agree that the European Organisation for Technical Assessment (EOTA), the designated
TAB’s and the European Commission shall be informed about the content of this application;
 I will bear the costs of issuing the European Technical Assessment according to the contract
with Kiwa;
 I will support the assessment procedure as required and agreed in a subsequent contract;
 I will ensure that the manufacturing plant(s) can be visited at any time during the operating
times by representatives of Kiwa;
 I further declare that I am prepared to inform Kiwa without delay of the first making available of
the product on the market with CE marking.
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(Place and date)
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(Stamp/Signature)
4
Where the construction product is to be produced
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Form sheet application ETA according to CPR version 29-10-2013