申请编号:                                     生产厂编号：   

Application No:                                Factory No:

CCC认证申请书

Application for the CCC Certification

首次申请     □            再次申请  □

First Application                      Second Application

申请日期/Date：

产品类别/Product sort:

中国质量认证中心

China Quality Certification Centre

1．申请人/Applicant:

1.1申请人名称/Name of Applicant:                                          

1.2 付款人名称、地址/Name 、Address of Payer:                           

                                                                     

1.3申请人地址、邮编/Address and post code of Applicant:                    

                                                                    

1.4 组织机构代码：

1.5联系人/Contact Person:    

1.6电话/ Telephone:                                         1.7传真/Fax:

1.8电子邮件/E-mail:                      

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 CCC代理申办机构注册证书号/ Register Number Of CCC Agent:                             

3. 制造商/Manufacturer（where the equipment is produced）:

3.1制造商名称/Name of Manufacturer:                                                     

                                                                      

3.2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:                   

4. 生产厂/Factory（where the equipment is produced）:

4.1生产厂名称/Name of factory:                                          

                                                                     

4.2生产厂地址、邮编/Address and 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（中文）/Model and specification:                                   

型号和规格（英文）/Model and specification:                                     

                                                                       

9. 申请认证产品的GB标准号/ GB standard for the equipment to be certified:

9.1安全标准/Standard for Safety:                                              

9.2 EMC标准/Standard for EMC(如有/If applicable):                           

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                                             否/No

如果有,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：                                                   

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、说明生产厂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模式：  £普通类型   £OEM   £ODM   £其他利用已获证书结果

A.选择本次申请的获证模式为“ODM”，出现下面两个选项：

£ 本次申请拟利用ODM生产厂已有CCC证书的结果   选择此项显示：请正确填写ODM生产厂已有CCC证书（初始认证证书）的证书号             

£ 作为ODM初始认证证书持证人身份申请

B.如果选择本次申请的的获证模式为“其他利用已获证书结果”，则出现如下界面：  请正确填写拟利用的已获证书结果的证书号             

C.如果选择本次申请的获证模式为“OEM”，选择此项显示：请正确填写相关联的OEM证书号：             

注：若原获证产品的关键项目发生变更（如规格、结构、关键原材料/元器件及其供应商变更）时，本ODM产品也应随之变更并办理变更手续。原产品未涉及上述变更时，本产品也不能变更。

   Note: If the original products are changed (for example: specification, structure, critical materials/ components and their suppliers), then the ODM products shall also make the modification application. If the original products are not changed, then the ODM product shall not be changed.

14、备注/Remark：

                                                                           

我们声明我们将遵守中国质量认证中心的认证规则和程序，支付认证所需的申请,试验, 工厂审查及其它有关的费用；妥善保管型式试验报告、工厂检查报告和认证变更确认等认证的相关资料，以备监督检查使用；中国质量认证中心将不承担获得产品合格认证的制造厂或销售商应承担的任何法律责任。

We declare that we will follow the rules and procedures of the CQC and make payment for the fees arising from the application, testing, inspection and other services, keep well type test report, factory inspection report, materials approving for change of certified product and relevant documents of certification in order to conduct the factory follow up inspection. China Quality Certification Center shall not bear any corresponding legal liabilities which should be assumed by Manufacturer and Seller with product certificate.

我们声明所生产的本申请所涉及的产品符合申请认证产品的GB标准及其它相关标准或规定，我公司对次声明完全负责。

We declare with full responsibility that the relevant product(s) produced by our factory are in conformity with the GB standards and other standards or regulations.

授权人签章/Authorized signatory                                   

注/Note:
1、申请人应将申请书寄受理部门。/The applicant should send the application to CQC product department.
  本申请受理部门/Product department：

地址/Address：中国北京南四环西路188号9区 /Section 9,No.188,Nansihuan(the South Fourth Ring Road)Xilu(West Road),Beijing 100070,China    邮编/Postcode：100070

联系电话/Telephone：

2、请用中、英二种文字填写申请人、制造商、制造厂和认证产品的名称。/Please fill in the names of the applicant, factories and products in both Chinese and English.
3、有关CQC产品认证的公开文件可通过上网获取, 网址是http://www.cqc.com.cn//Published documents on CQC product certification can be acquired from CQC website:http://www.cqc.com.cn/
4、可以登陆CQC网站进行在线申请。网址是http://www.cqc.com.cn/The customer can logon CQC website to apply online, website:http://www.cqc.com.cn/
5、如果申请CCC认证，同时也申请CB测试证书，请填写完"申请人承诺"后，继续填写CB测试申请书。/If CB application applied at the same time with CCC application, please complete "Declaration of the Applicant" and then to fill in CB application form.
6、CCC认证与CB认证同时申请时，制造商必须相同。/If CCC certification and CB certification apply at the same time, the manufacturer of them must be the same.
7、CB申请书以英文填写为准，相同的内容可以复制。/The english content of CB application is admitted, the same contents of it can make duplicate.

8、申请人获证后有关证书注销、暂停（恢复）、撤销等重要信息，中国质量认证中心将以“通知书”形式按上述“申请人”信息中的内容以“挂号信”方式进行邮寄、告之。如持证人证书内容（申请人/制造商/生产企业名称、地址等）发生变化，请及时申请证书变更。除证书内容外，申请人/代理机构/制造商/制造厂其他内容发生变化，请及时联系受理工程师修改。/China Quality Certification Center will take in the form of “Notice” to notify certificate holder the information of cancellation, suspension (resumption), and withdrawal. The “Notice” will send by registered letter according to the address of applicant information. If there is any change on certificate contents (applicant/manufacturer/name or address of factory), please apply the certificate modification in time, except that, if the change on applicant/ agency/manufacturer/ factory, please contact with engineer in time.

    9、申请人获证后有关证书注销、暂停（恢复）、撤销的信息，请登录中国质量认证中心或认监网网站进行查询。同时申请人需将证书注销、暂停（恢复）、撤销的信息及时通知与之相关的制造商、生产厂，并按照强制性产品认证的相关规定执行。/The certificate holder can land on China Quality Certification Center website (www.cqc.com.cn) or Certification and Accreditation Administration of the People’s Republic of China website (www.cnca.gov.cn) to get the information on certificates cancellation, suspension (resumption) and withdrawal. In addition, the applicant should notice the related manufacturer or factory the information of certificates cancellation, suspension (resumption) and withdrawal, and comply with related CCC requirements.

申 请 人 承 诺

1) 始终遵守认证计划的安排的有关规定；/we undertake to always comply with the relevant provisions of the certification programme;
    2）为进行评价作出必要的安排，包括审查文件、进入所有的区域、查阅所有的记录（包括内部审核 报告）和评价所需人员（例如检验、检查、评定、监督、复评）和解决投诉的有关规定；/we undertake to make all necessary arrangements for the conduct of the evaluation, including provision for examining documentation and access to all areas, records (including internal audit reports) and personnel for the purposes of evaluation (e.g. testing, inspection, assessment, surveillance, reassessment ) and resolution of complaints;
    3） 仅在获准认证的范围内作出有关认证的声明；/we undertake to make claims regarding certification only in respect of the scope for which certification has been granted;
    4） 在使用产品认证结果时，不得损害（认证机构名称）的声誉、不得做使(认证机构名称)认为可能误导或未经授权的声明；/we undertake to not use our product certification in such a manner as to bring CQC into disrepute and do not make any statement regarding our product certification which CQC may consider misleading or unauthorized;
    5） 当证书被暂停或撤销时，应立即停止涉及认证内容的广告，并按中国质量认证中心（CQC）要求 交回所有认证文件；/we undertake to upon suspension or cancellation of certification, discontinue the use of all advertising matter that contains any reference thereto and return any certification documents as required by CQC;

    6） 认证仅用于表明获准认证的产品符合特定标准；/we undertake to use certification only to indicate that products are certified as being in conformity with specified standards;
    7） 确保不采用误导的方式使用或部分使用认证证书和报告；/we undertake to endeavour to ensure that no certificate or report nor any part thereof is used in a misleading manner;
    8） 在传播媒体中对产品认证内容的引用，应符合中国质量认证中心（CQC）的要求。/we undertake to in making reference to our product certification in communication media such as documents, brochures or advertising, comply with the requirements of CQC.

9）此申请中的产品符合国家其它相关法律法规的要求后方可出厂销售。The product in this application can be sold only if it fully conforms to our country's laws and regulations。

申请人授权签字/ Signature authorized by the applicant：

                           年/Year     月/Month      日/Date