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1、 消 防 电 子 产 品 质 量 检 验 申 请 表APPLICATION FORM FOR THE QUALITY APPROVAL TEST OF FIRE ELECTRONIC PRODUCT 申请企业名称 Applicant Firms Name 企业法人代表Firms Legal Representative （ 签字 ） （Signature） （加盖公章）（Official Seal of the Applicant）填报日期： 年 月 日Date:中国国家消防电子产品质量监督检验中心印制Printed and Distributed by China National Supe
2、rvision and Test Center for Fire Electronic Product Quality注 意 事 项Notice to Matters Concerned 1请用正楷字填写检验申请表。 Please fill in the Application Form by the regular script2封面企业法人签字处应由企业法人亲自签写。 The artificial person should sign in the cover of this form3企业联系人应是企业法人授权的、具有全权处理有关检验事宜资格的人员。必要时，企业法人应在检验申请表中注明检
3、验报告领取人。 The linkman should be the personnel，authorized by the artificial person，deal with matters about the test of your productsIf it is necessary，the artificial person should designate the person who will take away the test report in the Application Form申 请 企 业 概 况General Description of the Applic
4、ant Firm申请企业名称、地址、邮政编码Applicant firmsname, address and post code法人及联系人姓名、电话、传真Name, telephone and fax offirms legal person andcontact person生产厂名称、地址、邮政编码Name, address and post codeof the factory厂长及联系人姓名、电话、传真Name, address and faxof the head of the factory and contact person企业产品质量检验能力Capability for t
5、he qualityapproval test of the firm产品生产日期及出厂检验情况Manufacturing date andsummary about the producttest in manufacturer申 请 检 验 产 品 情 况Description of the Product Applied for Test序 号Serial No.产品名称Name of Product型号规格Model and specification执行标准Implemented standard商 标Trademard主型产品Major Model Product分型产品Sub-m
6、odel Product申请检验产品名称、型号及照片Name, Model and Photograph due to be Applied for Test主型产品Major Model Product贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product贴 照 片 处Photograph of the product
7、 stickup here名 称 型 号Name Model分型产品Sub-Model Product 贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product 贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product 贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Prod
8、uct 贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model分型产品Sub-Model Product贴 照 片 处Photograph of the product stickup here名 称 型 号Name Model简要说明送检产品的用途和特点Summary about Usage and Feature of the Product提交中心送检产品技术资料明细表（需标明资料名称、页数及份数）The List of Technical Document to be Submitted（including Name
9、、 Number of Copies and Pages）每种分型产品与主型产品的区别Difference between Major Model and Sub-model Product 企业负责人： Person in Charge of Quality：企业对产品检验的要求或其他需说明的事项Some Necessary Requirements of the Firm for the Product Test 企业负责人： Person in Charge of Quality：注：Notes：1. 请按要求填写检验申请表一式一份，并附产品照片三张（125mm88mm）Please f
10、ill in the form in 1 copy according to the requirements, and enclose 3 pieces of photos （125mm88mm） with.2. 提交企业注册证明复印件Please submit the certificate of your commercial registration.3. 提交技术资料：a) 产品安装使用说明书一式两份；b) 产品设计计算说明书一式一份；c) 产品调试大纲一式一份；d) 产品机械设计图纸一式一份；e) 产品电路设计图纸及元器件明细表（包括印刷线路板图、程序框图）一式一份；f) 送检产品
11、如无对应国家标准，应提供企业标准两份，同时提供市级以上技术监督部门同意实施该企业标准的批文。The technical documents to be submitted：a. Instruction of the use and installation, 2 copies;b. Instruction of the product design and calculation, 1 copy;c. Guide to product adjustment, 1 copy;d. Mechanical drawing of the product, 1 copy;e. Circuit diagr
12、ams, and list of the parts of the product（including the PCB diagram the program software flow diagram）, 1 copy;f. If no China National Standards corresponding to your approving product, the test report and corresponding standards provided by relevant approval organization should be submitted to our
13、center.4. 样本数量：a) 每种型号的火灾报警控制器三台、与其配套的探测器每台两只及最大负载条件下的等效负载；（如火灾报警控制器为总线制，需增加与其配套的探测器十只。）b) 每种型号的探测器二十二只；c) 手动火灾报警按钮十四只；d) 消防应急灯具三台；e) 如送检产品无对应国家标准，样品数量应与企业标准要求相符。Numbers of the samples：The samples to be selectively submitted according to the test items.a. Control panel：3 pieces with 6 detectors（each
14、 panel with 2 detectors）and necessary equivalent loads in maximum load condition（if working on the bus type, 10 pieces of this type detector should be attached to one of the control panels）;b. Detector：22 pieces;c. Manual call points：14 pieces;d. Fire emergency lighting appliances：3 pieces;e. Other
15、products corresponding to no China National Standards, the numbers of the products should be submitted according to test items.5. 通讯地址：单位名称：国家消防电子产品质量监督检验中心地 址：辽宁省沈阳市皇姑区蒲河街七号帐 户：国家消防电子产品质量监督检验中心开 户 行：中国银行黄河分理处帐 号：831360413808091001电 话：024-86807982 86801434电 挂：6195 沈阳传 真：024-86801434邮政编码：110031Commun
16、ication to the Center：Name：National Supervision and Test Center for Fire Electronic Product QualityAddress：7, Puhe Street, Huanggu District, Shenyang, P.R.China.Bank：Subbranch of Huanggu District of Shenyang, Bank of China.Account Number：831360413808091001Telephone：0086-24-86807982 86801434Fax：0086- 24-86801434Post Code：1100316. 样品编号Sample number7. 国内产品送检请省、自治区、直辖市消防局（处）介绍信Please submit introductive letter from fire bureau for homemade products.注：此页由检验中心填写Notes: this page should be filled in by the test center检 验 方 案（合 同）评 审 记 录检验申请受理人受理时间评审内容：参评人员：年 月 日评审结论：批准人： 年 月 日国家消防电子产品质量监督检验中心
