Microsoft Word - PCM TL-Ed.4.4(特定電気用品適合性検査申込のご案内)

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1 (

2 (1) 3 (2) (1) (2) 1 2

3 ( PSE-RE-101/205/306/405 2 PSE-RE-201 PSE-RE-301 PSE-RE-401 PSE-RE-302 PSE-RE-202 PSE-RE-303 PSE-RE-402 PSE-RE-203 PSE-RE-304 PSE-RE-403 PSE-RE-204 PSE-RE-305 PSE-RE-404 PSE-RE-205 PSE-RE-306 PSE-RE-405 PSE-RE-701 PSE-RE-702 PSE PSE-RE-703 CB CB

4 3. (1) 2.(2) 6 (2) 8 1 (3) 9 2 2

5 1) 6 2) 3) (4) JET JET (1) JET (2) JET 7. JET

6 NMF 2F Tel JET

7 PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE PSE-RE RSE-RE RSE-RE-703

8 1-1 1 JET PSE-RE () TEL FAX

9 1-2 PSE-RE PSE JET JET JET JET 13JET 14JET 15JET JET 18JET 19JET JET 2050 JET 21 JET

10 2-1 2 JET PSE-RE () TEL FAX 2.

11 2-2 PSE-RE JET PSE-RE-202 PSE-RE-203 PSE-RE-701 PSE-RE-702 PSE-RE JET PSE-RE-204 CB CB 9. TEL/FAX TEL FAX

12 2-3 PSE-RE-202 JET JET

13 2-4 PSE-RE-203 JET TEL/FAX TEL FAX TEL/FAX TEL FAX TEL/FAX TEL FAX TEL/FAX TEL FAX JET TEL/FAX TEL FAX

14 2-5 PSE-RE-204 TEL FAX

15 2-6 PSE-RE PSE JET JET JET JET 13JET 14JET 15JET JET 18JET 19JET JET 2050 JET 21 JET

16 3-1 2 JET PSE-RE () TEL FAX 2.

17 3-2 PSE-RE JET PSE-RE-302 PSE-RE-303 PSE-RE-304 PSE-RE-701 PSE-RE-702 PSE-RE JET PSE-RE-305 CB CB 9. TEL/FAX TEL FAX

18 3-3 PSE-RE-302 JET 8. () TEL FAX

19 3-4 PSE-RE-303 I. II. JET JET

20 3-5 PSE-RE-304 JET TEL/FAX TEL FAX TEL/FAX TEL FAX TEL/FAX TEL FAX TEL/FAX TEL FAX JET TEL/FAX TEL FAX

21 3-6 PSE-RE-305 TEL FAX

22 3-7 PSE-RE PSE JET JET JET JET 13JET 14JET 15JET JET 18JET 19JET JET 2050 JET 21 JET

23 4-1 Form 4 Application for Conformity Assessment Project No. JET (To be filled in by JET) To Japan Electrical Safety & Environment Technology Laboratories 912 PSE-RE-405 We hereby apply for Conformity Assessment on the Specified Electrical Appliances and Materials as stated below, in order to obtain the Statement of Conformity as specified in the Article 9, Paragraph 1 of Electrical Appliances and Materials Safety Act. We submit this application accepting Conditions for Application for Conformity Assessment (PSE-RE-405) on the attachment to the application. 1. Applicant (manufacturer outside Japan) Company name Address The person responsible for the application Division / Post (Signature or seal) Address of the responsible person (If different from the above one of the Company) () TEL FAX 2. Details to the application As shown in the attachment 3. Official duplicate of the Statement of Conformity needcopy/copiesnot necessary

24 4-2 PSE-RE-401 JET PSE-RE-402 PSE-RE-403 PSE-RE-701 PSE-RE-702 PSE-RE JET PSE-RE-404 CB CB 9. TEL/FAX TEL FAX

25 4-3 PSE-RE-402 JET JET

26 4-4 PSE-RE-403 JET TEL/FAX TEL FAX TEL/FAX TEL FAX TEL/FAX TEL FAX TEL/FAX TEL FAX JET TEL/FAX TEL FAX

27 4-5 PSE-RE-404 TEL FAX

28 PSE-RE JET 4-6

29 5-1 Form 5 2 Application for Duplication of Statement of Conformity Assessment Project No. JET (To be filled in by JET) To Japan Electrical Safety & Environment Technology Laboratories We hereby apply for the official duplicate of the Statement of Conformity Assessment which was already issued. 1. Applicant (manufacturer outside Japan) Company name Address The person responsible for the application Division / Post (Signature or seal) Address of the responsible person (If different from the above one of the Company) () TEL FAX 2. Name of Specified Electrical Appliances and Materials 3. Statement Number 4. The number of official duplicates to be issued:

30 5-2 Form 6 Application for a supplement (change) to the Statement of Conformity Assessment Project No. JET (To be filled in by JET) To Japan Electrical Safety & Environment Technology Laboratories PSE-RE We hereby apply for a supplement (change) to the Statement of Conformity Assessment according to the change of an entry (entries). We submit this application accepting Conditions for Application for Conformity Assessment(PSE-RE-205, PSE-RE-306 or PSE-RE-405) on the attachment to the application. 1. Applicant (manufacturer outside Japan) Company name Address The person responsible for the application (Signature or seal) Division / Post Address of the responsible person (If different from the above one of the Company) () TEL FAX 2. Name of Specified Electrical Appliances and Materials 3. Statement Number 4. Changed entry (entries) of the Statement of Conformity Assessment (Please tick the appropriate box) Name, address of the applicant Name, address of the factory Relocation of the factory Addition of a factory (another factory of the same legal person that applied for the Statement of Conformity Assessment)

31 5-3 PSE-RE-601 Annex to Application (Form 6) for a supplement (change) to the Statement of Conformity Assessment 1. Description of the change Before the change Project No. JETTo be filled in by JET After the change 2. The cause of the change (The date of the change) 3. Documents The applicant shall submit the following documents to JET for each application. Copy of the Statement of Conformity Assessment List of Inspection Facilities ( required for each factory if it has been relocated or added ) 4. The applicant shall submit the following documents to JET when applicable. PSE-RE-204, PSE-RE-305, PSE-RE-404 Power of Attorney (PSE-RE-204, PSE-RE-305 or PSE-RE-404): necessary when the application is made by an agent 5. Official duplicate of the Statement of Conformity need copies Not necessary 6. Request or information, if any.

32 5-4 PSE-RE-602 Information for Interaction (if the contact person is not the person responsible for the application) Project No. JETTo be filled in by JET Contact information for this application is as follows. Point of Contact Name of company Address Division / Position Name in charge TEL FAX The contact person shall be a member of the applicant or its properly authorized agent (the valid POWER of ATTORNEY: PSE-RE-404 is necessary for the authorization). Annex to Application (Form 5) for Duplication of Statement of Conformity Assessment Annex to Application (Form 6) for a supplement (change) to the Statement of Conformity Assessment

33 6-1 JET 1. () TEL FAX

34 6-2 (A) (B) (C) (D) (E) (F) (G) (H) (I) (1) 125 V (2) 125 V (1) 10 VA (2) 10 VA 20 VA (3) 20 VA 30 VA (4) 30 VA 40 VA (1) 50 Hz (2) 60 Hz (1) (2) (1) 15 V (2) 15 V 30 V (3) 30 V 60 V (4) 60 V (1) (2) (1) (2) (1) (2) (1) (2) (J) (1) (2) (K) (L) (M) (N) (O) (P) (1) (2) (3) (4) (1) (2) (3) (1) (2) (3) (1) (2) (3) (4) (1) (2) (1) (2) z ON-OFF

35 6-3 PSE-RE-701 ABC-1234P z

36 6-4 PSE-RE

37 6-5 Questionnaire for scheduling the Authorized Inspection Facilities Field Verification PSE Scheme Operational and Regulatory Documents OD-JETPSE0008 : Project No. JET (To be filled in by JET) 1 Manufacturer s registered name and factory address Name Address 2 Contact person in factory a. Name Department / Post TEL FAX b. Name of deputy contact person in factory Department / Post TEL FAX 3 Direction for reaching the factory (Please make sure the nearest railway station, the airport, and attach a copy of local map.) 4 Applicant or Agent Name in block Signature Date In the case a certified testing laboratory authorized to conduct factory inspection at your factory site by JET asks you to pay the inspection fee to the laboratory, please do so.

38 V (1) 1.5 (2) 100V (1) 1.5 (2)

39 (1) 1.5 (2) 500 (1) 1.5 (2) (1) 1.5 (2)

40 (1) 1.5 (2) (1) 1.5 (2) (1) 1.5

41 (2) (1) 1.5 (2) (1) 1.5 (2)

42 6-7 PSE-RE mm mm 150 mm 0.01 mm 500V DC 500 V 100 MΩ 100 V 3,000 V 500 VA 3 kv V 130 V 2 kva 150/300 V /30 A

43 100 V 130 V 2 kva 150/300 V /30 A /240 V240 W

137. Tenancy specific information (a) Amount of deposit paid. (insert amount of deposit paid; in the case of a joint tenancy it should be the total am

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