ANNEX IVSupplementary provisions
ANNEX IV Certification forms Text of image CERTIFICATE OF CONFORMITY OF ENTITY IN CHARGE OF MAINTENANCE confirming acceptance of the maintenance system of an entity in charge of maintenance (ECM) within the European Union in conformity with Directive (EU) 2016/798 of the European Parliament and of the Council and Commission Implementing Regulation (EU) 2019/779 1. EIN number 2. CERTIFIED ENTITY IN CHARGE OF MAINTENANCE Legal title: Commercial designation or acronym (voluntary) Complete postal address (street, postal code, city, country) Registration business number: VAT No: 3. CERTIFICATION BODY Legal title: Complete postal address (street, postal code, city, country) Certification body reference number: 4. CERTIFICATE INFORMATION This is a — new certificate EIN number of the previous certificate: — renewed certificate — updated/amended certificate Validity from: to: Type of company: (railway undertaking, keeper, maintenance supplier, etc.) 5. SCOPE OF ECM ACTIVITIES Category of vehicles: (freight wagons, locomotives, multiple units, passenger carriages, high-speed vehicles, OTMs, other) Covers wagons specialised in transport of dangerous goods YES/NO 6. ADDITIONAL INFORMATION Date issued Signature Internal reference number Certification body’s stamp Text of image CERTIFICATE OF CONFORMITY FOR MAINTENANCE FUNCTIONS confirming acceptance of the maintenance system within the European Union in conformity with Directive (EU) 2016/798 of the European Parliament and of the Council and Commission Implementing Regulation (EU) 2019/779 1. EIN number 2. CERTIFIED ORGANISATION Legal title: Commercial designation or acronym (voluntary) Complete postal address (street, postal code, city, country) Registration business number: VAT No: 3. CERTIFICATION BODY Legal title: Complete postal address (street, postal code, city, country) Certification body reference number: 4. CERTIFICATE INFORMATION This is a — new certificate Identification numberof the previous certificate: — renewed certificate — updated/amended certificate Validity from: to: Type of company: (railway undertaking, keeper, maintenance supplier, etc.) 5. SCOPE OF MAINTENANCE ACTIVITIES Category of vehicles: (freight wagons, locomotives, multiple units, passenger carriages, high-speed vehicles, OTMs, other) Covers wagons specialised in transport of dangerous goods YES/NO 6. MAINTENANCE FUNCTIONS Maintenance development YES NO Fleet maintenance management YES NO Maintenance delivery YES NO For partial maintenance functions, the sub-functions for which this certificate is valid (see list in Annex II to Implementing Regulation (EU) 2019/779: Text of image 7. ADDITIONAL INFORMATION Date issued Signature Internal reference number Certification body’s stamp