belgelendirme merkezi - polat güvenlik sistemleri

%(/*(/(1'ø50(0(5.(=ø
h5h1%(/*(/(1'ø50(%$ù9858
FORMU
CERTIFICATION APPLICATION FORM
Doküman No
UB-FR-001
ƒ›Çƒ”‹Š‹
15.07.2014
Revizyon Tarihi
15.07.2014
No : 0
$$%(/*(7$/(3('(1.858/8ûCERTIFICATE REQUESTED BY
(1) .XUXOXüXQDG× / Company Name :
1(7(/6$1(/(.(/(.76ø66$17ø&/7'ù7ø
(2) Vergi Dairesi No / Vat No :
267ø0
(3) Adresi / Address :
%$7,6ø7(6ø0$+$//(6ø62.$.(6.ø62.$.12
(4) Posta Kodu / ZIP Code :
(5) ûHKLU / City :
ANKARA
(6) Ülke / Country :
7h5.ø<(
(7) úUWLEDWWDQVRUXPOXNLüL / Contact person $<ù(*h/.$5$*g=
(8) Tel / Telephone :
903122571163
(9) Faks / TeleFax :
903122570750
(10) E-Posta / E-Mail :
[email protected]
$%%$û9858'$%8/81$1.858/8û817(06ú/&ú6úAPPLICANT'S REPRESENTATIVE ((ùHUYDUVD / if any)
(1) .XUXOXüXQDG× / Company Name :
1(7(/6$1(/(.(/(.76ø66$17ø&/7'ù7ø
(2) Vergi Dairesi No / Vat No :
(3) Adresi / Address :
%$7,6ø7(6ø0$+$//(6ø62.$.(6.ø62.$.12
(4) Posta Kodu / ZIP Code :
-
(5) ûHKLU / City :
ANKARA
(6) Ülke / Country :
7h5.ø<(
(7) úUWLEDWWDQVRUXPOXNLüL / Contact person
(8) Tel / Telephone :
903122571163
(9) Faks / TeleFax :
903122570750
(10) E-Posta / E-Mail :
-
$&)$785$1,1.(6ú/(&(øú$'5(6INVOICE ADDRESS(ùHUEDüYXUX\X\DSDQGDQIDUNO×LVHLIRWKHU
than applicant)
(1) .XUXOXüXQDG× / Company Name :
1(7(/6$1(/(.(/(.76ø66$17ø&/7'ù7ø
(2) Vergi Dairesi No / Vat No :
6310092271
(3) Adresi / Address :
%$7,6ø7(6ø0$+$//(6ø62.$.(6.ø62.$.12
(4) Posta Kodu / ZIP Code :
06530
$$h5(7ú&úMANUFACTURER (ùHUEDüYXUX\X\DSDQGDQIDUNO×LVHif other than applicant)
(1) .XUXOXüXQDG× / Company Name :
(2) Vergi Dairesi No / Vat No :
(3) Adresi / Address :
(4) Posta Kodu / ZIP Code :
(5) ûHKLU / City :
(6) Ülke / Country :
(7) úUWLEDWWDQVRUXPOXNLüL / Contact person
(8) Tel / Telephone :
(9) Faks / TeleFax :
(10) E-Posta / E-Mail :
%(/*(/(1'ø50(0(5.(=ø
h5h1%(/*(/(1'ø50(%$ù9858
FORMU
CERTIFICATION APPLICATION FORM
Doküman No
UB-FR-001
ƒ›Çƒ”‹Š‹
15.07.2014
Revizyon Tarihi
15.07.2014
No : 0
$%h5(7ú0<(5ú)$%5ú.$MANUFACTURING PLACE - FACTORY LOCATION(ùHUUHWLFLGHQIDUNO×LVHif
other than manufacturer)
(1).XUXOXüXQDG× / Company Name :
1(7(/6$1(/(.75ø.(/(.7521ø.6ø67(0/(5ø6$1$<ø9(
7ø&$5(7/ø0ø7('ùø5.(7ø
(2) Vergi Dairesi No / Vat No :
267ø09'
(3) Adresi / Address :
*(56$16$1$<ø6ø7(6ø62.$.12(5*$=ø
(4) Posta Kodu / ZIP Code :
(5) ûHKLU/ City :
ANKARA
(6) Ülke / Country :
7h5.ø<(
(7) úUWLEDWWDQVRUXPOXNLüL / Contact person
(8) Tel / Telephone :
0.312.2571163-64
(9) Faks / TeleFax :
0.312.2570750
(10) E-Posta / E-Mail :
$%(/*(7$/(3('ú/(1h5h10$08// CERTIFICATE REQUESTED PRODUCT
Belgelendirmeye
Esas Doküman/
(Standard/Kriter vb)
Basic Certification
Document /
(Standard/Criteria etc)
1. TS EN 54-3,, <font color=red>TS EN 54-3/A2
Tescilli Marka/
NETELSAN
Trade Mark
7LFDUL0RGHO(ùHU
varsa)
hUQ$G×
Product Name
hUQg]HOOLNOHUL6×Q×I7LS7U&LQVYE
Product Specifications (Class, Type etc.)
Trade Model (If any)
.219$16ø<21(/<$1*,1 g]HOOLN)/$ùg5/h9(<$)/$ùg56h=0(75('(G%6(6
ø+%$56ø5(1ø
<$<$%ø/(1ø+%$56ø5(1ø
.219$16ø<21(/
)/$ùg5/h<$1*,1ø+%$5
6ø5(1ø
*HUHNL\RUVDHNVD\IDNXOODQÕQÕ]/use additional sheet if necessary
%(/*(/(1'ø50(0(5.(=ø
h5h1%(/*(/(1'ø50(%$ù9858
FORMU
CERTIFICATION APPLICATION FORM
Doküman No
UB-FR-001
ƒ›Çƒ”‹Š‹
15.07.2014
Revizyon Tarihi
15.07.2014
No : 0
$%%(/*(7$/(3('ø/(1h5h1/(5ødø1$<1ø<(7%(<$1,1,=9$56$
PRODUCT IDENTITY DECLARATION FOR CERTIFICATE REQUESTED PRODUCT (IF ANY)
6DGHFH$\QL\HWEH\DQÕNDEXOHGLOHQUQOHULoLQD\QL\HWHHVDV%HOJHQXPDUDVÕQÕEHOLUWLQL]
Please indicate certificate number demonstrating identity for only products identity declaration is
accepted)
Ayniyet Beyan Durumu
$\QL\HW%H\DQÕ<RN
$\QL\HWøOLúNLOL%HOJH1RCertificate No
Ayniyet Gösterilen Firma
Ayniyet Gösterilen Üretim Yeri
$7$/(3('ú/(1%(/*( / CERTIFICATE REQUESTED
T*
%(/*(d(ûú'ú&(57,),&$7(7<3(
7(6&ú//ú0$5.$/$5
REGISTRATED MARKS **
1.
(x)
7h5.67$1'$5'/$5,1$8<*81/8.%(/*(6ú
CERTIFICATE OF CONFORMITY TO TURKISH STANDARDS
2.
( )
( )
( )
.5ú7(5(8<*81/8.%(/*(6ú&(57,),&$7(2)
CONFORMITY TO CRITERIA
376(<,/',=%(/*(6ú&(57,),&$7(2)76(
STAR (*)
476(dú)7<,/',=%(/*(6ú&(57,),&$7(2)
TSE DOUBLE STAR (**)
5.
( )
+$5021ú=('2.h0$1/$5$8<*81/8.%(/*(6ú
TSE-HAR CERTIFICATE
6.
( )
( )
( )
( )
(/(.7520$1<(7ú.8<80/8/8.%(/*(6ú
ELECTROMAGNETIC COMPATIBILITY CERTIFICATE
7.
(1(&%(/*(6ú(1(&&(57,),&$7(
8.
([.$/ú7(8<*81/8.%(/*(6ú&(57,),&$7(2)
CONFORMITY TO TSE Ex QUALITY
9()250$/'(+ú7(0ú6<21%(/*(6ú
E0 FORMALDEHYDE EMISSION CERTIFICATE
10.
( )
( )
( )
( )
()250$/'(+ú7(0ú6<21%(/*(6ú
E1-FORMALDEHYDE EMISSION CERTIFICATE
11.
%ú5ú0'2ø58/$0$%(/*(6ú&(57,),&$7(2)81,7
VERIFICATION
14.
'(1(<%(/*(6ú
TEST CERTIFICATE
12.
&&$175%(/*(6ú&&$175&(57,),&$7(
15.7ú3%(/*(6ú7<3(&(57,),&$7(
13.
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CB TEST CERTIFICATE
16.'úø(527+(5
%(/*(/(1'ø50(0(5.(=ø
h5h1%(/*(/(1'ø50(%$ù9858
FORMU
CERTIFICATION APPLICATION FORM
Doküman No
UB-FR-001
ƒ›Çƒ”‹Š‹
15.07.2014
Revizyon Tarihi
15.07.2014
No : 0
7DOHEOHULQL]L;LúDUHWLLOHEHOLUWLQL]In this 7HVFLOOL0DUNDODUÕQGL÷HUNXOODQÕPúHNLOOHULQHLOJLOL76(%HOJHOHQGLUPH8VXOYH
section please indicate the certificate by ticking
(VDVODUÕQDwww.tse.org.trµGDQXODúÕODELOLU
you are requesting
(***)Belge talep edilen ürün, 76(EHOJHOLROPDOÕGÕU%HOJHOLGH÷LOLVH76(EDúYXUXVX\DSÕOPDOÕGÕU
$7$/(3('ú/(1'(ø(5/(1'ú50(7h5h8\JXQRODQ×LüDUHWOH\LQL]
TYPE OF EVALUATION REQUESTED (Mark the appropriate one)
(x)
úONEDüYXUX<HQLEHOJHFirst application (New certification)
( )
6WDQGDUW.ULWHU'HùLüLNOLùLStandard/Criteria changes
( )
.DSVDPJHQLüOHWPHScope expanding
( )
hUHWLP<HULGHùLüLNOLùLManufacturing Place Changes
( )
6WDWhQYDQ'HùLüLNOLùLStatus/Title change
( )
7LFDUL0DUNDGHùLüLNOLùL/ Trade Mark changes
'LùHU2WKHU%HOLUWLQL]/Please Indicate)
A6%$û9858<$.218h5h118081(/(5úX\JXQRODQ×LüDUHWOH\LQL]
TEST SPECIMENS (mark the appropriate one)
(x)
+D]×UUHDG\
( )
7DULKLQGHKD]×URODFDNZLOOEHUHDG\RQ
%(/*(/(1'ø50(
0(5.(=ø&(57,),&$7,21&(17(5+ø=0(7
6g=/(ù0(6ø6(59,&($*5((0(17
Doküman No
UB-FR-001
ƒ›Çƒ”‹Š‹
15.07.2014
Revizyon Tarihi
15.07.2014
No : 0
$%$û98586$+ú%ú1ú1%(<$19(ú0=$6,/ DECLARATION AND SIGNATURE OF THE APPLICANT
³76(%HOJHOHQGLUPH<|QHUJHVL´³76(hUQ%HOJHOHQGLUPH8VXOYH(VDVODUÕ´YH³76(hUQ%HOJHOHQGLUPH
hFUHWOHQGLUPH(VDVODUÕYHhFUHWdL]HOJHOHUL´LOH76(¶QLQEXQDLOLúNLQGL÷HULGDULG]HQOHPHOHULQLQEWQLGDULPDOL
WHNQLNYHKXNXNLKNPYHúDUWODUÕLOHEXQODUGD\DSÕODFDNWPGH÷LúLNOLNOHULD\QHQNDEXOHWWL÷LPL]LYH
\NPOONOHULPL]L\HULQHJHWLUHFH÷LPL]LEDúYXUXLOHLOJLOL76(WDUDIÕQGDQJHUoHNOHúWLULOHQKL]PHWOHUYH
J|UHYOHQGLULOHQKH\HWOHULQXODúÕPNRQDNODPDYHKDUFÕUDKJLGHUOHULQHDLWWDKDNNXNHWWLULOHFHNIDWXUDODUÕKLoELULKWDUYH
LKEDUDO]XPEÕUDNPDGDQ|GH\HFH÷LPL]LEDúYXUXLOHLOJLOLEHOJHOHQGLUPHQLQJHUHNWLUGL÷LELOJLGRNPDQYHPHNDQODUD
76(WDUDIÕQGDQJ|UHYOHQGLULOHFHNX]PDQYENLúLQLQNLúLOHULQHULúLPLQLVD÷OD\DFD÷ÕPÕ]ÕEDúYXUXNRQXVX
EHOJHOHQGLUPHLúOHPOHULQGHLúVD÷OÕ÷ÕYHJYHQOL÷LLOHLOJLOLKHUWUOWHGELULDODFD÷ÕPÕ]ÕEDúYXUX\ODLOJLOLRODUDN
LVWHQHQWPLGDULYHWHNQLNGRNPDQODUÕQYHELOJLOHULQWDUDIÕPÕ]FDHNVLNYHYH\DKDWDOÕWHVOLPHGLOPHVLQGHQGR÷DFDN
JHFLNPHYHLúOHPOHULQVRQXoODUÕQGDQVRUXPOXRODFD÷ÕPÕ]ÕYH76(DGÕQDJ|UHYOHQGLULOHQSHUVRQHOLOHEXIRUPGD
LUWLEDWWDQVRUXPOXRODUDNEH\DQHGLOHQNLúLNLúLOHUWDUDIÕQGDQEDúYXUXNRQXVXLOHLOJLOLRODUDN\UWOHFHNKHUWUOLúYH
LúOHPHDLWND\ÕWDOWÕQDDOÕQDFDNUDSRUYHEHQ]HULWPVRQXoODUÕNDEXOHGHFH÷LPL]L76(DGÕQDJ|UHYOLSHUVRQHOHWPEX
LúOHPOHUHVQDVÕQGDKHUWUONROD\OÕ÷ÕVD÷OD\DFD÷ÕPÕ]ÕEDúYXUXGDEXOXQGX÷XPX]UQOHLOJLOL76(WDUDIÕQGDQEHOJH
ORJRYHYH\DPDUNDNXOODQPD\HWNLVLYHULOPHGHQUQQXPXQHYHEXQODUÕQDPEDODMODUÕLOHUHNODPNDWDORJYEIL]LNL
YH\DGLMLWDORUWDPODU]HULQGH76(¶\HDLWPDUNDORJRYHEHQ]HUOHULQLNXOODQPD\DFD÷ÕPÕ]ÕKHUWUODQODúPD]OÕN
KDOLQGH7UNL\H&XPKXUL\HWLNDQXQODUÕX\JXODQDFD÷ÕQÕGR÷DFDNLKWLODIKDOLQGHLID\HULPDKNHPHOHULYHLFUDGDLUHOHUL
LOHELUOLNWH$QNDUDPDKNHPHOHULYHLFUDGDLUHOHULGH\HWNLOLRODFD÷ÕQÕNDEXOYHWDDKKWHGHUL]We, hereby,
acknowledge that we exactly agree on each administrative, financial, technical and legal provisions and terms included in
“TSE Certification Directive”, “TSE Product Certification Procedures and Principles” and “TSE Product Certification
Pricing Principles and Price Lists” and other related administrative TSE arrangements together with amendments and
changes to be made on the same and will fulfill our responsibilities; will pay invoices to be accrued for services to be
provided by TSE in connection with the application, for travel, accommodation fees and other related allowance without
giving rise to any notice or request; will make available information, documents and access to places required by
certification process to person(s) to be assigned by TSE; will take each action and/or measure relating to occupational
health and safety during the certification process; will be responsible for any delay arising from insufficient or faulty
delivery of any administrative or technical document requested for the application and for results of related transactions;
will agree on any report or similar document to be prepared for any work or procedure to be conducted in relation to the
application by person(s) to be stated as the contact person in this form and other personnel to be assigned by TSE; will
assist the personnel assigned by TSE in such work; will not use any TSE mark, logo, etc. on any product, sample and
package of the same and any hard or soft promotion material such as catalogs before TSE grants the power to use the said
certificate, logo and/or mark for any product, sample and their packages; that in case of any dispute courts and execution
offices of where the agreement is made and Ankara Courts and execution offices will be competent and laws of Turkish
Republic will apply.
<XNDUÕGDYHULOHQELOJLOHUYHWDDKKWP]oHUoHYHVLQGHKXNXNHQVDKLELEXOXQGX÷XPX]UQYHWHVFLOOLWLFDULPDUND
ODUWHVFLOOLUQDGODUÕLoLQ\DSWÕ÷ÕPÕ]UQEHOJHOHQGLUPHEDúYXUXVXQXQ³76(%HOJHOHQGLUPH<|QHUJHVL´YH³76(
hUQ%HOJHOHQGLUPH8VXOYH(VDVODUÕ´QDX\JXQRODUDNGH÷HUOHQGLULOPHVLQLWDOHSHGHULPWithin the framework of the
information provided above, we request evaluation of our product certification application for the products and registered
trademark(s) / brand name(s) we legally own, in accordance with “TSE Certification Directive” and “TSE Product
Certification Procedures and Principles”.
%DüYXUXVDKLELDG×QDUHVPL\HWNLOLRODUDN / formally act on
behalf of
$G× / Name :
1(&0(7'ø18=81
Tarih / Date :
21.04.2015
úP]D/ Signature
.DüH / Stamp :
%(/*(/(1'ø50(
0(5.(=ø&(57,),&$7,21&(17(5+ø=0(7
6g=/(ù0(6ø6(59,&($*5((0(17
Doküman No
UB-FR-001
ƒ›Çƒ”‹Š‹
15.07.2014
Revizyon Tarihi
15.07.2014
No : 0
/WIHQDúD÷ÕGDNLGRNPDQODUÕ76(ZHEVD\IDVÕQGDQwww.tse.org.tr) inceleyiniz/Please review the following
documents from the TSE web site (www.tse.org.tr).
øODYH$oÕNODPDODUYH7HNQLN'RNPDQODULoLQSupplementary Technical DocumentsøODYHWHNQLNGRNPDQODU
NRQXVXQGDhUQ%HOJHOHQGLUPH%DúYXUX5HKEHULQHEDNÕQÕ]For additional technical documents Please refer to
“Product Certification Aplication Guide” from TSE web page (www.tse.org.tr).
** ³76(%HOJHOHQGLUPH<|QHUJHVL´LOJLOL³76(hUQ%HOJHOHQGLUPHXVXOYHHVDVODUÕ´YHLOJLOL³76(hUQ
%HOJHOHQGLUPHhFUHWOHQGLUPH(VDVODUÕYHhFUHWdL]HOJHOHUL” ni www.tse.org.trZHEVD\IDVÕQGDQLQFHOH\LQL]
Please refer to “TSE Certification Directive”, “TSE Product Certification Procedures and Principles” and “TSE
Product Certification Pricing Principles and Price Lists” from TSE web page (www.tse.org.tr).
$û$ø,'$.ú'2.h0$1/$5,(./(<ú1ú= / ADD TO THIS DOCUMENT
D%DúYXUXVDKLELNXUXOXúXQ\DVDOVWDWVQJ|VWHUHQUHVPLELUEHOJHAn official document stating legal status of
the applicant organization.
E%DúYXUXVDKLELNXUXOXúXWHPVLOYHLO]DPD\HWNLOLRODQNLúLQLQNLúLOHULQLP]DVLUNOHUL1RWHUWDVGLNOLBook of
authorized signature of the person(s) with representative and binding authority of the applicant organization
F0DUNDWHVFLOEHOJHVLRQD\OÕVXUHWLNotarised copy of certificate for registration of trademark.
G%DúYXUXVDKLELNXUXOXúLOHUHWLFLNXUXOXúELUELULQGHQIDUNOÕLVHDUDODUÕQGD\DSÕODQV|]OHúPH6|]OHúPH
³76(%HOJHOHQGLUPH<|QHUJHVLYH76(hUQ%HOJHOHQGLUPH8VXOYH(VDVODUÕ¶QÕQEWQLGDULPDOLWHNQLNKXNXNL
KNPYHúDUWODUÕQÕD\QHQNDEXOHGLOGL÷LQHYH\NPOONOHULQ\HULQHJHWLUHFH÷LWDDKKWQ´LoHUPHOLGLU) /If the
applicant organization and the owner of the production site are different from each other, the document showing the
agreement between them.
e) Avans dekontu/3UHSD\PHQW5HFHLSW76(GHQEHOJHOLNXUXOXúODUGDQLVWHQPH]
I6HNW|UH|]HOPHY]XDWúDUWODUÕQÕQ\HULQHJHWLULOGL÷LQHGDLUQRWHURQD\OÕL]LQEHOJHOHULVXUHWOHULCopies of
documents signed by an authority, stating that legal legislation requirements are fulfilled related with the sector
J$\QL\HWEH\DQÕIdentity declaration