FORM OF THE CERTIFICATE OF CONFORMITY
ANNEX IVSupplementary provisions
ANNEX IV FORM OF THE CERTIFICATE OF CONFORMITY … (name) with registration number ……………………………………………………………………………… accredited for the scope ……………………………………………………………………………… (NACE Code) declares, after having verified the installation of the economic operator ……………………………………… (name) located in ……………………………………… with registration number (if available) ………………………………………, that the installation meets all the requirements laid down in Annex I of Regulation (EU) 2025/2365 of the European Parliament and of the Council of 12 November 2025 on preventing plastic pellet losses to reduce microplastic pollution. By signing this declaration, I declare that: — the verification has been carried out in compliance with the requirements of Regulation (EU) 2025/2365, including spot checks performed on … (dates), — the outcome of the verification confirms that there is no evidence of non-compliance with the requirements of Regulation (EU) 2025/2365. Done at ………………………………………, on …/…/20… . Signature and stamp or digital signature