ANNEX IV FORM OF THE CERTIFICATE OF CONFORMITY

ANNEX IV

FORM OF THE CERTIFICATE OF CONFORMITY

… (name)

with registration number ………………………………………………………………………………

accredited for the scope ……………………………………………………………………………… (NACE Code)

declares, after having verified the installation of the economic operator ……………………………………… (name) located in ……………………………………… with registration number (if available) ………………………………………,

that the installation meets all the requirements laid down in Annex I of Regulation (EU) 2025/2365 of the European Parliament and of the Council of 12 November 2025 on preventing plastic pellet losses to reduce microplastic pollution.

By signing this declaration, I declare that:

Done at ………………………………………, on …/…/20… .

Signature and stamp or digital signature