ANNEX IISupplementary provisions
ANNEX II TEMPLATE FOR ‘EC’ DECLARATION OF VERIFICATION OF SUBSYSTEM ‘EC’ declaration of verification of subsystem ‘EC’ declaration identification number [ERADIS ID] ( 1 ) We, Applicant: [Business name] [Complete postal address] Declare under our sole responsibility that the following subsystem ( 2 ) : [Name/short description of the subsystem, unique identification of the subsystem] to which this declaration refers has been subject to the relevant verification procedures and complies with the relevant Union law and any relevant national rules: [Reference to: the Directive(s); TSI(s); Relevant national rules;] has been assessed by the following conformity assessment bodies: Notified Body: Business name Registration number Full address Designated Body: Business name Identification number Full address Assessment body [Risk assessment]: Business name Identification number Full address In accordance with the following certificate(s) and or report(s): [Certificate(s) number(s), report(s) number(s), date(s) of issue] The following conditions of use and other restrictions apply ( 3 ) : [List or reference to the list of conditions of use and other restrictions] The following procedures have been followed in order to declare conformity: [The modules chosen by applicant for the verification of the subsystem] Identification of the technical file accompanying this declaration [Reference to the technical file accompanying the ‘EC’ declaration of verification of subsystem in accordance with Article 15(4) of Directive (EU) 2016/797] Reference to former ‘EC’ declaration of verification (where applicable) [Yes/No] Done on: [date DD/MM/YYYY] Signature of Applicant First Name, Surname ( 1 ) The information in square brackets [ ] is provided to support the user in correctly and exhaustively compiling the template. ( 2 ) The description of the subsystem shall enable unique identification and allow for traceability. ( 3 ) When a reference to a list of conditions of use and other restrictions is made, such list shall be accessible to the authorising entity.