ロット認証申請書記載例（PDF版）
Contents
1. HU ELLE UD DU DU DU 5 GU UNE OUUTE OH Ul 1 12 HUU OCU BEROUN WUU UUE AU OU GA E EUO G O GU OOU U G EL2. k RIE PAS E Application for Lot Approval WRIBHEA WmCAWERERRS E To President Consumer Product Safety Association Applicant ZU FTF TACA Sn UAS tb 4 amp Company Name ZZ L 3b EL ARAZA Name of Representative and Signature fV Hx ZE BD ER f Address 7103 0023 p XLpEHAIAKBII 5 9 FAX 0519b517TJ 5411 AX p 1 4 Person in charge MAEHE ZEKER MAEAEA RER T RORE n vyv F ZEIL 15 We hereby pledge ourselves to abide by each of the following provisions and app Article 7 of the Procedural Manual prepared by the Consumer Product Safety Ass 4 Product Name DAF DAF AJ Model Name BR 0 BR 1 1 2 Quantity 5 000 6 000 AmA Product No 120214 120210 J vk a 2012 0H OF 2012 OHOR anufacturing Date AO E T X 4 Manufacturing Factory Be AE GRA moO F Import Country rH only for imports AFH H Desired Inspection Date du 35 15 pm Desired Inspection Place Hi 2012 FO H OH 20124FD HOH MERE ER MERE ER ABC ERARI i ABC HIRAF EE pu Fee 15 750 Hj 18 900 Hj FOSE Amount of fees 34 650 H E 0 E 1 5 Remarks 1 WARU 2 BHA atq 3 EROH SE SNEER ATIA BARRER L CAMT lc 4 FARCH R jud 1 clos 1 35 3 42 amp C XX
3. E 3 ATRA LT A SS ZEE E 2 XONI L7gV IL Remarks Keep blank the columns marked with X In case foreign applicant the Application is to file in duplicate each English and Japanese as possible Hv prania BIT 2S L ARAMEA RN m ZEE UR OO BOE KOEDEScXGtUIAEMBITRC6w nacxEEE3 5 54 TOMER 511290 LETA 2 KPRRRORLEZ B RE TERZ OLLEET 3 uv PREZ LERMA TORNMORMIC K SEL X AESEO BERE UT EANCU BI NO S5 0 511355 DEZ UEC Covenant with regard to the Application for Lot Approval 1l We will abide by the provisions set forth in the Consumer Product Safety Association s Procedural Manual follow instructions given by inspection institutes designated by the Association and will not engage in any immoral conduct 2 With regard to the management of SG marks we will assign one or more responsible person s who will take the responsibility of managing SG marks 3 In case of an accident or a similar problem resulting from a defect in a Lot Approved product necessary measures such as the withdrawal of all the products of the same model will be taken to safeguard the welfare of consumers D0000 00000 LL e BULL UL Eo qu
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