Form for nomination by manufacturer

To

The Director General,

Bureau of Indian Standard,
9, Bahadur Shah Zafar Marg,
New Delhi-110 002.

Subject: Nomination of Authorized Indian Representative

Dear Sir/Madam,

In terms of the clause (g) of sub-paragraph (1) of paragraph 3 of Scheme IV of BIS (Conformity
Assessment) Regulations, 2018, we, M/s , the manufacturer, do hereby nominate
and appoint Mr./Ms. , son / daughter of
Mr. , resident of
, INDIA, as our Authorized Indian
representative.

Mr./Ms. , would be the person responsible for and on our behalf

under the clause (g) of sub-paragraph (1) of paragraph 3 of Scheme IV of BIS (Conformity Assessment)
Regulations, 2018 for compliance of terms and conditions of certificate of conformity and also provisions
of the BIS Act 2016, Rules and Regulations. The form also contains his / her signatures in token of his /
her acceptance, consent and confirmation of the terms and conditions of the certificate of conformity.
Please be advised that the nomination in favour of the authorized India representative shall continue for
the purpose of this certificate of conformity till such time that some other person is appointed in his / her
place in accordance with the terms of clause (g) of sub-paragraph (1) of paragraph 3 of Scheme IV of BIS
(Conformity Assessment) Regulations, 2018.

Yours faithfully,
Signature of Authorized
Indian Representative:
Signature:
Name:
Name:

Designation: Designation:
Contact details: - Contact details:-
Mob. No.: Mob. No.:
Email: Email:
Complete postal Address: Date:
Seal: