Request form Conformity assessment

Dear Sir / Madam,

You want to submit an application for a conformity assessment. Before we can carry out this assessment, we need more data and documentation. You can pass this information on to Kalibra using this form.

If the entered data is unclear or incomplete, additional costs will unfortunately have to be charged.
To prevent unwanted delays during the assessment, we also ask you to ensure that the machine is provided with the so-called calibration plate including all mandatory inscriptions in advance.

Conformity request form

This form asks for information that is necessary for the conformity assessment

Requestor
Company name*
Name*
First name Last name
Address*
Street & number Address line 2 City State Postal code Country
E-mail address Requestor*
Phone number*
Your reference
Instrument location
Company name*
Address*
Street & number Address line 2 City State Postal code Country
Name contact person*
E-mail address contact person*
Phone number contact person*
The request concerns
Total amount:*
Please fill in the total amount of automatic weighing scales when they: 1- are of the same type; 2- have the same acceptance number 3- have the same weighing limit 4- are installed in the same location
Voer een nummer in van 1 tot 999.
Technical information
The request concerns:*
Class:*
Class X:*
Made as:*
Amount of filling heads:*
Voer een nummer in van 0 tot 20.
Describe execution*
Metrologic data
Manufacturer*
Type*
Year of manufacture*
Factory number*
Acceptance number*
Software version
Type loadcell(s)
Please upload the related test certificates in the section below
Type Indicator
Please upload the related test certificates in the section below
Metrologic date per section
Amount of weighing sections*
Section 1:
Section 1 Max =*
Section 1 Min =*
Section 1 Tarra =*
Section 1 e =*
Section 1 d =*
Section 1 Traject:*
Section 2:
Section 2 Max =*
Section 2 Min =*
Section 2 Tarra =*
Section 2 e =*
Section 2 d =*
Section 2 Traject:*
Section 3:
Section 3 Max =*
Section 3 Min =*
Section 3 Tarra =*
Section 3 e =*
Section 3 d =*
Section 3 Traject:*
Operational characteristics
Amount of different products*
Describe product 1*
Describe product 2:*
Describe product 3:*
Additional information/ Inscriptions
Upload the Declaration of Comformity*
Toegestane bestandstypen: pdf, Max. bestandsgrootte: 128 MB.
Upload the acceptance documents, test certificates and/or compatibility sheets.*
Sleep bestanden hierheen of

Toegestane bestandstypen: pdf, xlsx, xls, Max. bestandsgrootte: 128 MB.
Declaration from manufacturer
If the applicant is NOT the manufacturer, a statement from the manufacturer must be uploaded in which the applicant is authorized to use the authorizations and to issue a Declaration of Conformity
Toegestane bestandstypen: pdf, Max. bestandsgrootte: 128 MB.

Request form Conformity assessment

Conformity request form

Requestor

Instrument location

The request concerns

Technical information

Metrologic data

Metrologic date per section

Operational characteristics

Laat hier jouw gegevens achter en maak kans op een Kalibra rolmaat.

Quiz - gegevens