Application Form to Receive License to Mark Product with Standard Mark/Safety Mark

In Accordance with Standard: *

Application for (check the relevant box): *

New License
License Expansion

Full Registered Name of Manufacturer: *

Address of Manufacturer *

Phone Number *

Email *

Zip Code *

Fax number

Company number

P.O. Box

Company Website *

Application for a new License?

Yes
No

Has the manufacturer received a license in the past? *

No
Yes

For the following products *

Is the manufacturer already undergoing surveillance by SII? *

No
Yes

Check the relevant box *

ISO 9001
Standard/Safety Mark
Other

Describe *

We, the undersigned, request that the preliminary inquiries contract between us and between SII from this day,

Enter a date *

shall also apply to the above product, and in the event that the License Committee will grant the above product with a Standard Mark, it will be covered by a surveillance agreement that has been signed with SII from this day

Enter a date *

Does the manufacturer have approval for meeting the requirements of ISO 9001 by a source that is not SII? *

No
Yes

List name of the organization *

Does the manufacturer have approval of the product from a foreign institution? *

No
Yes

Describe *

How many employees are employed by the manufacturer? *

Position Holders at the Manufacturer

CEO *

CEO's phone number *

Position

Name

Phone number

Contact Person with SII

Name *

Cell number *

Position *

Email *

Phone number *

Attached Documents that Describe the Company and Product

Description/Diagram of Organization

Attach No file chosen

Quality Plan

Attach No file chosen

Other Documents

Attach No file chosen

Catalog of Products/ Services

Attach No file chosen

Product File

Attach No file chosen

Certificates of the Organization

Attach No file chosen

Flow Chart of Product Process

Attach No file chosen

Product Details

Product Name *

Product Description *

Details of all Product Models *

Are the products (or their parts) manufactured at additional sites?

No
Yes, describe:

Addresse site 1

Addresse site 2

Application for a new License?

Yes
No

Is there a supplier / sub-contractor? *

Yes
No

List the names of your main suppliers/sub-contractors and the materials/parts/services they provide:

Name of supplier/sub-contractor *

Type of material/part/service *

Address *

Additional suppliers/sub-contractors (Second)

Name of supplier/sub-contractor *

Type of material/part/service *

Address *

Additional suppliers/sub-contractors (Third)

Name of supplier/sub-contractor *

Type of material/part/service *

Address *

Additional suppliers/sub-contractors (Wednesday)

Name of supplier/sub-contractor *

Type of material/part/service *

Address *

We the undersigned hereby request for the product described here to be granted with the Standard/Safety Mark. We commit to:

A. Fulfill the requirements of the Standard Law of 1953 and the regulations issued thereunder, and the conditions and arrangements that were determined by the Standard Mark Directorate and License Committee that operate under it.

B. To allow the representative of the Director General of SII to come visit the factories and product assembly sites, as well as other factories that create the product, part of the product, or its components.

C. To enable and assist the representative of the Director General to take product samples or its part and materials used in its construction, for free, to conduct preliminary testing.

D. Not to publicize in any form that the factory or its products are under the surveillance of the Institute, currently or in the future, or are soon to be inspected, until receipt of the license by the Institute.

E. To bear the expenses related to the procedures described in this application.

Name *

Date *

Signature *

Position *

company stamp (A file with a company stamp must be attached) *

Attach No file chosen