Manufacturer Declaration of

Conformity
‫ﻧﻣﻭﺫﺝ ﺍﻟﺗﻌﻬﺩ ﻭﺍﻹﻗﺭﺍﺭ ﻣﻥ ﻗﺑﻝ ﺍﻟ ُﻣﺻﻧﻊ‬

A. Unique identification No of the electrical equipment under application

BRAND NAME Reference Standard MARKETING NAME MODEL NO.

(SASO-IEC…)

B. Manufacturer Details
Name of the Manufacturer:

Address of the Manufacturer:

Contact Person:

Email address:

Telephone / Fax no.:

Mobile phone no.:

C. Details of Authorized Representative / Importer in KSA

Name of Authorized Representative:

Address of Authorized Representative:

Commercial License No.:

D. Additional information

This is a self-declaration of compliance to National and/or International approved Standards and the applicable
Technical Regulation in the Kingdom of Saudi Arabia issued under the sole responsibility of the manufacturer

Signed for and on behalf of:

(Company Name):
(place and date of issue):

(Authorized Person Name and

Designation):
(signature):

(Company Stamp):

This form is to be printed on the Applicant's (Manufacturer) letterhead

CER-IE-F-02.v.1.0