BABT 781
Issue 03
Page 1 of 4
Application for a Marine Equipment
Directive Module F Product Verification
Certificate of Conformity
Section A:
A. 1
Application Details
Applicant Company Details
Please note the Certificate will be made issued listing the applicant company details. This company must be listed as
holder of the Module B Certificate referenced in this application
Company Name:
..............................................................................................................................
Address:
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
Postcode/Zip Code: ............................................... Country: ...............................................................
Please identify the contact person within the applicants company:
Title: ...................... First Name: ................................................ Last Name: : ......................................
Job Title and/or Department Reference: ................................................................................................
Telephone Number: ............................................... Fax Number: ........................................................
e-mail Address:
.....................................................................................................................
The above Applicant is the
(Please mark the applicable box)
A. 2
Manufacturer
Authorised
Representative
Other Contact information
Where the application is signed by the authorised representative on behalf of the manufacturer (who is the named
applicant) please provide contact details of the Authorised Representative:
Title: : .....................
First name: ...................................
Last Name: ...........................................
Job Title and/or Department Reference: ................................................................................................
Telephone Number: ............................................... Fax Number: ........................................................
e-mail Address:
.....................................................................................................................
Where you wish a Agent who is not an Authorised Representative to be involved please mark in the
box that you have provided full contact details of the Agent with this application including a letter of
appointment from the applicant
© TÜV SÜD BABT 2016
A Certification Body of TÜV SÜD
Application for a Marine Equipment Directive Product Verification Certificate of Conformity
BABT 781
Issue 03
Page 2 of 4
Section B: Your Module B TEC, Agreement, and USCG Details
Module B TEC Number for the Product
{ include NB number as “(xxxx)” where not TÜV SÜD
BABT}
Please provide the Agreement number and date of
issue under which this application is being made
Where your product is not listed in the Product Verification Agreement but is an identical brand
name of one that is listed please provide a brief justification why the agreement may be applied
to your product and permission from the holder of the Agreement to use the agreement
Where you wish TÜV SÜD BABT to allocate a US
Coast Guard number under the MRA please indicate
this here
Section C:
Commercial Information
Work is carried out on receipt of either payment in advance or a valid purchase order number.
Note: Where you have accepted a quotation from a TÜV SÜD office which includes this TÜV SÜD BABT Certification application
you do not have to complete this section.
Where you wish to pay in advance please either provide details of your credit
card in the box opposite or indicate you wish to select this type of payment and
contact customer.services@babt.com to arrange for the payment.
Where you select to use a purchase order please provide your company’s
Purchase order number in the box opposite.
Where you wish the invoice to be sent to a different person to the main contact
please indicate this in the box and provide the full details in supporting
information
Section D: Product Details
D. 1 Product(s) Submitted
Please enter the Product name(s), and model(s) for which you seek a Certificate of Conformity
Product Name(s)
Model(s)
D. 2 Information related to Lots/Batches tested
D.2.1
Where you have selected to test each item
Range or actual
Serial Numbers
of each item to
be included
Note: The included test reports must cover all the items listed above.
Application for a Marine Equipment Directive Product Verification Certificate of Conformity
D.2.2
BABT 781
Issue 03
Page 3 of 4
Where you have selected to test samples within a lot
Lot Identity
No in
Lot
First Serial Number
Last Serial Number
D.2.3 Where the Serial number/identifiers are not consecutive please provide details of the means to uniquely
identify a product, and in which lot it was manufactured:
..............................................................................................................................................................
..............................................................................................................................................................
Section E:
Reports of Testing and Declaration of Conformity
Please give test report numbers and issue status of the reports covering the testing performed on samples from lots
subject to this application (where more than 3 reports are submitted provide the additional information as appropriate.
Test Report No
Issue and/or date
Declaration of Conformity file identity
Issue and/or date
Application for a Marine Equipment Directive Product Verification Certificate of Conformity
BABT 781
Issue 03
Page 4 of 4
Section F: Agreement
The applicant named in A1 must complete this section:
I (We) hereby apply for a Certificate in relation to the specified product and agree to conform to the TÜV
SÜD BABT Certification Regulations;
and
I declare that the samples were taken and tested in accordance with Product Verification Agreement
listed in this application
and
I authorize TÜV SÜD BABT to discuss details related to this certification with the test facility, and
consultant (where I have named one) identified in this application;
and
*I (We) declare that the specified product is not the subject of an application to another Notified Body
under Directive 96/98/EC acting in a similar capacity to TÜV SÜD BABT
Signed for on behalf of the applicant
Authorised signatory:
.............................................................................................................................
Name in CAPITALS
............................................ Date:
...................................................
Company Name of Authorised signatory: ...............................................................................................................
{ where you are the Authorised Representative listed on the Module B TEC and applying for the Manufacturer please indicate this on the
“Company name” line. }
All work is undertaken under TÜV SÜD BABT’s standard terms & conditions and the specific conditions listed on this
form. A copy of the standard terms & conditions can be found on our website
 Certificates only relate to the product and build level of that product identified in the certificate.
 Certificates are not transferable.
 Changes to the Holders name or address must be notified to Customer Services in writing.
Please return your application to
TÜV SÜD BABT, Octagon House, Concorde Way, Segensworth North, Fareham, Hampshire, PO15 5RL, UK.
National Tel:
01489 558346
Fax:
01489 558101
International Tel
+44 1489 558346
Fax:
+44 1489 558101
Web Address:
http://www.babt.com
Email:
customer.services@babt.com
Please ensure you include copies of all listed Module B TECS issued by other Notified Bodies, a copy of the
test results, and any required letters.