DEKRA - Application / Order Form

Reference No on quotation QUA/      Order No:       Your reference      

请用英文填写，如用中文填写，我们将翻译成英文，经您书面确认后使用。

Application to perform the services selected in this form

Company: CANDYLED
1. Applicant:
公司名称（中文）      
(The info here like, company
name and address, will be Contact Person: Anouar Belkadi Gender Male
identical with that of Female
certificate.) Address: Immeuble 3S, Rue Abou Hamed El Ghazeli - 2035 Montplaisir - Tunis
- TUNISIA
（这里所填英文信息将应用于 公司地址（中文）      
测试证书；中文地址用于邮寄
资料。） City: Tunis

ZIP code: 2035 Country: Tunisia

Telephone: +216 71 120 210 Telefax: +216 70 200 902

E-Mail: contact@candyled.com

VAT No.:      

2. Manufacturer/licensee: Company: SKY INDUSTRIES

(if different from Contact Person: Anouar Belkadi Gender Male

applicant) Female
Address: Zone industrielle Zriba , 1182 Zaghouan-Tunisie

City: Zaghouan

ZIP code: 1182 Country: Tunisie

Telephone: +216 71 120 210 Telefax: +216 70 200 902

E-Mail: contact@candyled.com

VAT No.:      

3. Factory location: Company: SKY INDUSTRIES

(if different from Contact Person: Anouar Belkadi Gender Male

applicant) Female
Address: Zone industrielle Zriba , 1182 Zaghouan-Tunisie

City: Zaghouan

ZIP code: 1182 Country: Tunisie

Telephone: +216 71 120 210 Telefax: +216 70 200 902

E-Mail: contact@candyled.com

VAT No.:      

4. Product: 1- Street Lights CANDYLED LUMAX 100W 100-265V Please Attach:

AC 50Hz SMD A copy of the marking / label (Street Lights
2- Street Lights CANDYLED LUMAX 150W 175-265V CANDYLED LUMAX 100W 100-265V AC 50Hz
AC 50Hz SMD SMD and Street Lights CANDYLED LUMAX
150W 175-265V AC 50Hz SMD.
5. Type(s): Street Lights 1. Information about the principal electrical
characteristics (see technical data)
6. Trade name: CANDYLED 2. The users manual (for GS also a German v)
3. All available declarations concerning the
product (e.g. toxicity, ergonomics)
7. Technical data: Rated output 100w = (54-85VDC -700mA)X2 Nature of supply: SMPS Non Dimmable
voltage: 150w = (60-90VDC -2000mA) For both

Rated input 100 - 265 V For 100w and Rated frequency: 50 Hz For both
Voltage: 175 - 265 V For 150w

Class: Classe II For both Degree ofprotection: IP 65 / IK 08 For both

(if applicable)
Additional      
Information:

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DEKRA - Application / order Form

Reference No on quotation QUA/       Order No:       Your reference      
8. Requested services:
KEMA KEUR Keymark Basic Safety Test
KEMA KEUR <HAR> Attestation of Conformity for products
NRTL Listing Type Test for components
MET Listing Final Random Inspection EMC
MET Recognition Vendor Assessment Explosion safety (attachment required)
MET Classification Type test kWh Meters ATEX
MET-C Listing
MET Listing for Canada
MET-C Recognition
MET-C Classification
CB (CB certificate) Calibration ATEX approval production site
GS
ENEC Gaming IECEx
EMC
EMC Attestation of Conformity CE Medical devices FM
LVD Attestation of Conformity
MD Attestation of Conformity
DEKRASEAL Bauart geprueft
DEKRA SEAL Product Safety
DEKRA SEAL Usability/Performance
Other service (to be specified)
LM79 for Street light 100W and 150W + IP and IK for Street light 150W

11. Which national devialtions have to

9. New certification 10. Upgrade of existing certificate(s)
be included?
Complete testing of a new product Alternative/changed design Austria Belgium
Pre-shipment inspection Earlier Ref no: ... Denmark Finland
Acceptation of CENELEC NTR Alternative factory location France Germany
(CCA) Product variation (new type designation) Great Britain Greece
Acceptation of CB Test Certificate Adoption of another component Italy Luxembourg
with TRF as alternative Netherlands Norway
Certification for the following instead of Poland Spain
countries according to the Other:       Sweden Switzerland
accelerated CCA Procedure: Other: Tunisia
     

New testig : as requested in the

point (8)

12. Contractor will be 13. Samples 14. Reporting language

Manufacturer Samples will arrive at DEKRA in week English
04/09/2020 will arrive at DEKRA
Applicant Handling of test specimen(s) after testing Dutch
Other: All samples may be scrapped German
      Return all samples to applicant’s address
Return only undamaged samples

15. Other certification

Are you ISO 9000 certified? Other certificates:
yes, ISO 9001 valid till MAY 2021 NO
no

16. Declaration and We are the legal owner of the product(s) and trademark(s) detailed in section 6. For each country we indicated
signature of the in section 11, we have obtained, read and understood the corresponding Certification Body’s regulations and
applicant: undertake to conform with each of those said regulations and will pay all fees due. We attach Identity
Declaration/Statement(s) for identification
We have received and accepted the current version of DEKRA’s General terms and conditions for the
performance of assessment and certification services.
For GS certification we received and accepted DEKRA Testing and Certification GmbH’s General terms and
conditions.
Name: Anouar Belkadi Stamp

Place and date: Tunis 03/09/2020

Signature:

Remarks:认证结果和认证标志特别适用于出口产品

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