ANNEX V EU declaration of conformity

1. No … (unique identification of the product):

2. Name and address of the manufacturer and, where applicable, the manufacturer’s authorised representative:

3. This declaration of conformity is issued under the sole responsibility of the manufacturer:

4. Object of the declaration (description of the product sufficient for its unambiguous identification and allowing traceability; it may, where necessary for the identification of the product, include an image):

5. The object of the declaration referred to in point (4) is in conformity with this Regulation, the delegated act adopted pursuant to Article 4 and, where applicable, other Union harmonisation legislation:

6. References to the relevant harmonised standards or to the common specifications used or references to the other technical specifications in relation to which conformity is declared:

7. Where applicable, the notified body … (name, number) performed … (description of intervention) and issued the certificate or approval decision … (number):

8. Where appropriate, the reference to other Union law providing for the affixing of the CE mark that is applied:

9. The identification and signature of the person empowered to bind the manufacturer or the manufacturer’s authorised representative:

10. Additional information: