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广州赛宝认证中心服务有限公司 CEPREI Certification Body CCC认证申请书 Application for the CCC Certification 申请编号 Application No: 生产厂编号 Factory No: 产品类别 Product sort: 申请日期： Date: 1．认证委托人/Applicant: 1.1 认证委托人名称/Name of Applicant: 1.2 付款人名称、地址/Name Address of Payer: 1.3认证委托人地址、邮编/Address post code of Applicant: 1.4 a) 证书邮寄地址、邮编/Address post code of certificate mailing: b) 批准书/各类通知书邮寄地址、邮编/Address post code of approving for change of certification or notice of suspension, withdrawal, cancellation or resumption: 1.5 组织机构代码： 1.6联系人/Contact Person: 1.7电话/ Telephone: 1.8传真/Fax: 1.9电子邮件/E-mail: 1.10移动电话/Mobile phone: 2. 代理机构或中国办事处/Name of Agent or office in China: 2.1 代理机构/中国办事处名称/ Name of Agent or office in China: 2.2 联系人/Contact Person: 2.3电话/ Telephone: 2.4传真/Fax: 2.5电子邮件/E-mail: 2.6移动电话/Mobile phone: 3. 生产者（制造商）/Manufacturer（where the equipment is produced）: 3.1生产者（制造商）名称/Name of Manufacturer: 3.2生产者（制造商）地址/Address of Manufacturer: 3.3联系人/Contact Person: 3.4 电话/ Telephone: 3.5 传真/Fax: 3.6 电子邮件/E-mail: 3.7移动电话/Mobile phone: 4. 生产企业/Factory（where the equipment is produced）: 4.1生产企业名称/Name of factory: 4.2生产企业地址、邮编/Address post code of factory: 4.3联系人/Contact Person: 4.4电子邮件/E-mail: 4.5电话/ Telephone: 4.6传真/Fax: 4.7移动电话/Mobile phone: 4.8工厂编号/Factory Number： 5.产品名称/Name of Production: 6.产品类别/Product Sort： 7.产品商标/Trade mark: 8.型号和规格/Model specification: 9.产品认证依据/Standards of product certification: 10. 申请认证的产品是否有CB测试证书/Has the applying equipment been awarded the CB Test Certificate: □ 是/Yes 请给出CB测试证书的编号和获证日期/If Yes, give the number and date of the CB Test Certificate: a) CB证书号/No. Of CB Certificate: b) 获证日期/Issued Date: c) 颁发CB测试证书的认证机构/Name of the NCB issuing the CB Test Certificate： □ 否/No 11、申请CCC认证的同时，是否申请CB测试证书/ If to apply CB Certificate When apply CCC Certification: □ 是/Yes □ 否/No 12、说明生产企业是否有同类产品获得过CCC证书，如果有，请列出证书编号。Please indicate if the factory has ever obtained CCC certificates, if the answer is yes, then list the certificate No: 13、请选择本次申请的获证