ANNEX V EU DECLARATION OF CONFORMITY

Name and type and any additional information enabling the unique identification of the product with digital elements

Name and address of the manufacturer or its authorised representative

A statement that the EU declaration of conformity is issued under the sole responsibility of the provider

Object of the declaration (identification of the product with digital elements allowing traceability, which may include a photograph, where appropriate)

A statement that the object of the declaration described above is in conformity with the relevant Union harmonisation legislation

References to any relevant harmonised standards used or any other common specification or cybersecurity certification in relation to which conformity is declared

Where applicable, the name and number of the notified body, a description of the conformity assessment procedure performed and identification of the certificate issued

Additional information:

Signed for and on behalf of:

(place and date of issue):

(name, function) (signature):