Application Form

Name of the Organization* Yashka Infotronics Pvt Ltd

Scope of Certification* Medical Devices

*As to appear in Certificate

Certification Scheme/s: (Please tick the relevant requirement)

ISO 9001:2015 ISO 13485:2016* ISO 22000:2018*
ICMED 9000* ICMED 13485* ISO/IEC 27001:2013*
Any other, specify: (e.g. ISO 14001:2015 , ISO 45001:2018; ISO 21001:2018, etc.)
*Please fill the attached qUEStionnaire along with this application form

Details of Key personnel Name Designation e-mail id Mobile

Akshay Sangwan akshayk.sangwan@gm
Top Management Director 95920 95221
ail.com
Dipankar Aich Director yashkacontacts@gmail 86692 34153
Authorized Representative
.com
Location Title and Address* Contact Details Activities carried out*
(Please mention auditable locations) (e.g. Management, Human Resource, Marketing, Sales, Purchase, Design,
(Location Title, e.g. Main office / Corporate Office / Registered Development, Production, Engineering, Delivery, Testing, Implementation,
Office / Branch Office / Works / Unit / Site, etc.) Maintenance, Service Provision, Quality Control, Stores, Despatch)

Tel: 86692 34153

Corporate Office: e-mail : yashkacontacts@gmail.com Sales
1/22, Asaf Ali Road, Delhi, Central Delhi, Delhi, Web: www.yashka.io
India, 110002

Manufacturing Plant: Tel: 86692 34153

Parkhi Heights, Manngaon, e-mail : yashkacontacts@gmail.com Production, Engineering, Delivery, Testing,
Hinjewadi Phase 3, Pune, Web: www.yashka.io Implementation, Maintainance, Service,
Maharashtra, 411057 Production, Quality Control, Stores, Dispatch,
Finacial Management
Branch Office: Tel: 86692 34153
158, East Zone Corporate Office, e-mail : yashkacontacts@gmail.com Sales
Shyarma Prasad Mukherjee Road, Web: www.yashka.io
Tallygunge, Kalighat, Kolkata,
West Bengal, 700026
* As to appear in Certificate
Please insert / attach similar tables in case of more locations.

# Details of Outsourced Processes: (such as Design / Production processes / Services / Testing / Calibration etc.) :
Process Supplier / Sub-contractor Compliance Status or Control exercised
PCB Components Assembly Samridhhi Enterprises Testing

# Details of major Technical processes:

(e.g. Casting, Forging, Extrusion, Moulding, Machining, Fabrication, Pressing, Assembly, etc. in Manufacturing sector) (e.g. Stocking, Distribution, Data proce
(e.g. Risk Management, Change Management, Incident Management, Infrastructure Migration, Engineering and Development, Change Implementation, etc in

Machining, Fabrication, Assembly

# Details of statutory & regulatory aspects applicable to your product / services / processes: (Please provide copy)
(e.g. Licenses / Permissions / Certifications / Affiliations / Memberships etc.):
GST License MSME Certificate Udyog Adhar
*additional sheets may be attached in case the space provided is not sUFficient to provide the reQUired information.

Note-1: If the Application is filled electronically, no signature is required

Note-2: Filling and submitting of this application form does not bind the applicant organization to obtain audit and certification services from ZQAPL

ZQAPL/F-01/16-07-2021 (Cl. Page 1 of

 Application Form

Please specify the location and department wise man-power in front of the processes

Department / Activity Location-1 Location-2 Location-3

Sr. (e.g. Management, Human Resource, Marketing, Sales,
On On On
Purchase, Design, Development, Production, Quality Full Full Full Remarks / Comments
No. Control, Stores, Despatch, Testing, Implementation, time
Contract
time
Contract
time
Contract
Maintenance, Service Provision,, etc.) / Part / Part / Part
time time time
1. Top Management 2
2. Human Resource 1
3. Sales/Marketing 1 1 2
4. Purchase 1
5. Design, Development (if applicable) 2
6. Production (Staff) 7
7. Production (Worker) 7
8. QA & QC (In charge)
9. QA & QC (Executive)
10. Service Provision (if applicable) 2 1 2
11. Stores/Despatch 1
12. Engineering & Execution 1
13. Testing, UAT, etc 1
14. Deployment , Delivery
15. Project Maintenance
16. IT / Service Desk/ Infra etc 1

Total 3 19 7 4
* In case of working in MUltiple shifts please fill in Appendix -A.
In-case of additional information of locations USe additional sheet identical to above table

a) When (Month-Year) do you expect the Audit and Certification to take place? Jan-2022
b) Is Design applicable to the scope of certification? Yes
c) Do you have a consultant? if yes, please specify name. CS Kamlesh Mishra
d) Which day is weekly off for your organization? Sunday
e) Is the organization working in multiple shifts? (If yes, please fill up the table on last page) NO
f) What are your working hours? (Timing hh: mm to hh: mm) 9:00 to 7:00
g) Language to be used during conduct of audit English / Hindi / Marathi
h) Have you availed any services from Astute Labs Pvt. Ltd.? (If yes, please provide details) NO
i) Is your organization already certified for any system or product certification scheme other NO
than you have applied for?
(If yes, please specify the name of the Certification Scheme, Certification Body and
Accreditation Board).
j) Is your organization already an applicant / certified for the certification scheme you have Yes
applied for and you want to change your present certification service provider?
(If yes, please mention the name of certification body and attach a copy of the certificate Geoteck Global
along with the last audit/NC report). In addition, answer the following questions;
(i) Any Complaints received and action taken (major complaints): NIL
(ii) Any current engagement by the organization with regulatory bodies in respect of legal YES / NO
compliance.
k) In case of transfer of certifying body, please mention the reasons for seeking the transfer. Change of accreditation

l) Are you already certified by ZQAPL for the applied Standard. If yes, under which NO
Accreditation
m) Compliance to conduct of minimum one round of Internal Audit and Management Review YES

n) Compliance to complete cycle of product manufacturing i.e. batch manufacturing for applied YES
scope) / cycle of development or Service providing (SDLC)

Signature of authorized representative : Date :23/12/2021

Name : Dipankar Aich Designation: Director

Note-1: If the Application is filled electronically, no signature is required

Note-2: Filling and submitting of this application form does not bind the applicant organization to obtain audit and certification services from ZQAPL

ZQAPL/F-01/16-07-2021 (Cl. Page 2 of

Application Form
Appendix A
Please specify the location and department wise man-power in front of the activity

Shift timings (Location-1) General : 1st Shift : 2nd Shift : 3rd Shift :

No. of personnel
Department / Activity
(e.g. Management, Human Resource, Marketing, On On On On
Sales, Purchase, Design, Development,
Full time Contract/ Full time Contract/ Full time Contract/ Full time Contract/
Production, Quality Control, Stores, Despatch,
Testing, Implementation, Maintenance, Service Part time Part time Part time Part time
Provision,, etc.)

Total

Shift timings (Location-2) General : 1st Shift : 2nd Shift : 3rd Shift :

No. of personnel
Department / Activity
(e.g. Management, Human Resource, Marketing, On On On On
Sales, Purchase, Design, Development,
Full time Contract/ Full time Contract/ Full time Contract/ Full time Contract/
Production, Quality Control, Stores, Despatch,
Testing, Implementation, Maintenance, Service Part time Part time Part time Part time
Provision,, etc.)

Total

Shift timings (Location-3) General : 1st Shift : 2nd Shift : 3rd Shift :

No. of personnel
Department / Activity
(e.g. Management, Human Resource, Marketing, On On On On
Sales, Purchase, Design, Development,
Full time Contract/ Full time Contract/ Full time Contract/ Full time Contract/
Production, Quality Control, Stores, Despatch,
Testing, Implementation, Maintenance, Service Part time Part time Part time Part time
Provision,, etc.)

Total
(Add tables in case of more locations)

Note-1: If the Application is filled electronically, no signature is required

Note-2: Filling and submitting of this application form does not bind the applicant organization to obtain audit and certification services from ZQAPL

ZQAPL/F-01/16-07-2021 (Cl. Page 3 of