‫مؤسسة المواصف ات والمق اييس‬ ‫طلب إصدار شهادة مطابقة للمنتجات المصدرة‬

‫مديرية شهادات المطابقة‬

‫ ذ‬JSMO/ Certification Department Application for Conformity Certificates for Exported Products
ّ .‫ّوتعدوالته‬2000/22ّ‫ّمنّقانونّادلؤدِةّرقم‬22ّ‫ّالصادرةّمبوجبّادلادة‬2018/2ّ‫هذاّالطؾبّمؼدمّدلـحّذفاداتّادلطابؼةّلغاواتّالًصدورّبـاءًّعؾىّتعؾقؿاتّرقم‬ 
This application is for granting conformity certificates for exportation according to instructions No. 2/2018 issued by article 22
from the institution law No. 22/2000 and its amendments.
Manufacturer's Name: ّ ّّّّّ:‫ادمّالشركةّالصانعة‬
Exporter's Name: Tel.: ّ
ّ :‫ّّّّّّّّّّّّّّّّّّّّّّّّّّّّّهاتف‬:‫ادمّادلصدر‬
ّ Address: P.O Box: Postal Code:
ّ ّّّّّّّّّّّّّّّّّّّ:‫ّّّّّّّّّّّّّّّّّّّّّالرمزّالربودي‬:‫ّب‬.‫ّص‬:‫عـوانه‬
Imported Country: ّ :‫اليؾدّادلًِورد‬
Importer's Name: ّ :‫ادمّادلًِورد‬
Invoice No.: Invoice Date: ّ :‫تارخيفا‬ ّ ّ:‫ّرقمّالػاتورة‬
Departure Border: Arrival Border: ّ :‫مقـاءّالوصول‬ ّ ّ:‫مقـاءّالشَن‬
Transportation: Country of Origin: ّ :‫بؾدّادلـشأ‬ ّ ّ:‫ودقؾةّالشَن‬
Certificate Language: No. of additional Copies: ّ ّ:‫عددّالـِخّاإلضافقةّادلطؾوبة‬ ّ :‫لغةّالشفادة‬
The sampling will be done by: ّ :‫دقًمّدَبّالعقـاتّمنّقيل‬
 Certification Department  Applicant ّ .‫ّمؼدمّالطؾب‬ّّّّّّّّّّّّّّّّ.‫ّمدوروةّذفاداتّادلطابؼة‬
Requirements which the results will be evaluated against: ّ :‫املتطلباتذاليتذدوتمذتقوومذالنتائجذبناءًذعلوها‬
ّ ‫رقمّالياركود‬ ‫الؽؿقة‬ ّ ‫نوعّالًعيىة‬ ّ ‫تاروخّاإلنًاج‬ ّ ّ‫رقمّالًشغقؾة‬ ّ ‫العالمةّالًٍاروة‬ ّ )‫*ادمّالصـفّ(ادلـًج‬
Barcode no. ّ Quantity ّ Packaging Production Date ّ Batch No. Trade Mark Product Name
ّ ّ ّ ّ ّ ّ ّ
* It is possible to use the provided attached table in case previous table is not )‫*(ّميؽنّادًُدامّادلؾَقّاإلضايفّيفّحالّملّوؽػيّاجلدولّالِابقّمعّاإلذارةّلذلك‬
enough (Reference it) ّ

ّ :‫يفّحالّمتّالؽشفّمنّقيلّمفـدديّقِمّذفاداتّادلطابؼةّجيبّحتدودّاآلتي‬
In case an inspection is required by certification body:
Inspection place: ّ ّّّّّّّّّّّّّ:‫مؽانّالؽشف‬
Name & Tel. of an exporter's representative:
ّ :‫ادمّوّهاتفّمـدوبّاجلفةّادلصدرةّادلًواجدّعـدّالشَـة‬
We, the organization signed below, are committed to the following: ّ :‫ذنتعهدذبااللتزامذمباذيلي‬،‫ذاملوقعةذأدناه‬،‫حننذالشركة‬
ّ‫االدًعدادّالًامّبااللًزامّبًعؾقؿاتّذفاداتّادلطابؼةّوتوفريّكلّماّوؾزمّلًطيققّإجراءات‬ .1
1- To comply with the certification instructions and provide whatever
needed to apply its procedures and implementing appropriate changes ّ‫مـحّالشفاداتّوااللًزامّبأيّتغقرياتّتطر ّعؾىّمًطؾياتّمـحّالشفادةّعـدّإعالمـاّبفا‬
when they are communicated by the certification department. ّ ‫منّقيلّمدوروةّذفاداتّادلطابؼة‬
2- To Withdraw samples that represent the whole batch intended for ّ‫ّيفّحالّمتّدَب‬،‫دَبّعقـاتّمتٌلّالشَـةّادلصدرةّتيعاًّإلجراءاتّذفاداتّادلطابؼة‬ .2
exportation according to conformity certificates procedures, in case we
did the sampling. ّ .‫العقـاتّمنّقيؾـا‬
3- Inform CT immediately of any changes or amendments that take ّ‫إبالغّمدوروةّذفاداتّادلطابؼةّوبدونّ يّتأخريّبأيّتغرياتّ وّتعدوالتّقدّتطر ّوّتؤثر‬ .3
place and may affect the certification requirements. ّ .‫عؾىّمًطؾياتّمـحّالشفادة‬
4- By signing the application, we are approving on the testing lab and ّ‫ّنعًربّموافؼنيّعؾىّخمًرباتّالػَصّاليتّدقًمّفَصّالعقـات‬،‫يفّحالّتوققعّالطؾب‬ .4
the inspector performing the inspection on the batch. ّ .‫بفاّوعؾىّادلػًشّالذيّدقؼومّبالًػًقشّعؾىّالشَـة‬
5- Make all necessary arrangement for the participation of observers, if ّ ‫ادلواف ؼةّعؾىّمشاركةّمراقبّلعؿؾقةّالؽشفّإنّلزمّاألمرّوعؿلّالرتتقياتّالالزمة‬ .5
applicable.
6- Not to use the conformity certificate in a way that disrepute ّ ‫عدمّادًُدامّذفادةّادلطابؼةّبطروؼةّتِيءّإديّادلدوروة‬ .6
certification
7- Inform certification department of any complaints raised against ّ‫اعالمّمدوروةّذفاداتّادلطابؼةّبأيّذؽوىّضدّادلـًٍاتّاحلاصؾةّعؾىّالشفادةّواختاذ‬ .7
certified product related to conformity of the product to the
certification requirements and take appropriate actions ّ ‫اإلجراءاتّادلـاديةّدلعاجلةّالشؽوى‬
8- Provide certification department with all necessary documents and ّ‫توفريّكلّماّوؾزمّمنّوثائقّومعؾوماتّوتِفقلّعؿؾقاتّالؽشفّعؾىّاليضاعةّمنّقيل‬ .8
information and make all necessary arrangements for certification
department to conduct the inspection. ّ ‫مدوروةّذفاداتّادلطابؼة‬

9-Inform certification department within 10 working days if he want to ّ‫ّ وامّعؿلّيفّحالّوجود‬10ّ‫إعالمّادلدوروةّبربيًهّبإعادةّفَصّالعقـاتّادلرجعقةّخالل‬ .9

re-test the retained sample (in case of nonconformity in test results). ّ ‫خمالػةّيفّنًائجّالػَص‬
10- commitment to follow up his application within 30 days, otherwise ّ ً‫ّووماًّوإالّوعًربّالطؾبّالبقا‬30ّ‫ االلًزامّمبًابعةّالطؾبّعـدّتؼدميهّخالل‬.10
his application considered cancelled.
3 ‫ من‬1 ‫صفحة‬ CTqf-093-01, rev.n
 ‫رقمّالياركود ّ‬ ‫الؽؿقة‬ ‫نوعّالًعيىة ّ‬ ‫تاروخّاإلنًاج ّ‬ ‫رقمّالًشغقؾةّ ّ‬ ‫العالمةّالًٍاروة ّ‬ ‫ادمّالصـفّ(ادلـًج) ّ‬
‫‪ّ Barcode no. ّ Quantity‬‬ ‫‪ّ Packaging‬‬ ‫‪Production date‬‬ ‫‪ّ Batch No.‬‬ ‫‪Trade mark‬‬ ‫‪Product name‬‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
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‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬
‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬ ‫ّ‬

‫صفحة ‪ 2‬من ‪3‬‬ ‫‪CTqf-093-01, rev.n‬‬

 Name and Signature of Applicant: ‫ ذ‬:‫ادمذوتوقوعذمقدمذرلبذاحلصولذعلىذذهادةذاملطابقة‬
‫ذ‬

Tel. number: ‫ ذ‬:‫رقمذاهلاتف‬

‫ذ‬
‫ذ‬

Date of Submitting Application: ‫ ذ‬:‫تاريخذتقديمذالطلب‬

Confidentiality obligations
CT is obliged to hold all the ORG information and documents,
which are not publicly known, confidential. Data that is
demanded by the accreditation bodies and competent authorities
who are entitled by law and legislation to access these
information and documents are excluded
‫االلتزامذبالدريةذذذ ذ‬
ّ‫تؾًزمّمدوروةّذفاداتّادلطابؼةّباحملافظةّعؾىّدروةّادلعؾوماتّاليتّتعًربّبريّمعؾومة‬
ّ،‫لؾعؿومّواليتّمتّاحلصولّعؾقفاّمنّادلـشأةّ ثـاءّتطيققّإجراءاتّمـحّذفادةّادلطابؼة‬
ّ‫والّوشؿلّذلكّادلعؾوماتّاليتّوًطؾبّعرضفاّهلقىاتّاالعًؿادّوالِؾطاتّاليتّحيقّهلا‬
ّ .‫االرالعّعؾىّهذهّادلعؾوماتّمبوجبّالؼانونّوالًشروعات‬

Filled by the certification department: ‫ذ ذ‬:‫خاصذمبديريةذذهاداتذاملطابقة‬

Application Review: Date: ّ :‫ّّّّّّّّّّّّّّّّّّّّّّّّّّّّّّّّّ ّ الًاروخ‬:‫مراجعةّالطؾب‬
Application Recipient: Application No.: ‫ذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذ ذ‬:‫مدتلمذالطلب‬
‫ ذ‬:‫رقمذالطلب‬

Date of receiving or Related Labs: ‫ ذ‬:‫املخترباتذاملعنوة‬ ‫ذ ذ‬:‫تاريخذادتالمذأوذدحبذالعونات‬

withdrawing the samples:
The condition of the
received sample / samples:
 Good and can be tested.
 Good and can depend on
previous test results.
 Not suitable to be tested.
 Others, mention them:
 Complying of product's label
to the standard related.
 No samples received.
Name of consignment inspector:
Proforma invoice no.:
Application recipient's notes:
‫ذذذذذ ذ‬
‫ذ‬
 JSMO labs.
 RSS labs.
ّ .‫ّخمًربّمؤدِةّادلواصػاتّوادلؼاوقس‬ ‫ ذ‬:‫ذالعوناتذاملدتلمة‬/‫حالةذالعونةذ‬
 No tests are required ّ .‫ّخمًربّاجلؿعقةّالعؾؿقةّادلؾؽقة‬ ّ .‫ّجقدةّوميؽنّحتووؾفاّلؾػَص‬
to be done on the
products. ّ .‫ّخمًربّ مانةّعؿان‬ ّ .‫ّجقدةّوميؽنّاعًؿادّنًائجّفَصّدابؼة‬
 Municipality labs.
ّ .‫ّادلـًجّالّحيًاجّلػَص‬ ّ .‫ ّبريّمـاديةّلًَووؾفاّلؾػَص‬
ّ :‫ّاذكرها‬،‫ّ خرى‬ ّ .‫ّمطابؼًفاّدلًطؾياتّبطاقةّاليقانّاخلاصةّبفا‬
ّ ّ ّ.‫ّملّوًمّدَبّعقـات‬
ّ ّ:‫ادمّادلػًشّعؾىّالشَـة‬
ّ :‫رقمّ مرّالؼيض‬
ّ ّ:‫مالحظاتّمًِؾمّالطؾب‬
ّ

ّ
Final Evaluation: ‫ ذ‬:‫التقوومذالنهائي‬
The test results:
 All the results of the samples tested were conforming. :‫نًائجّالػَصّادلُربي‬
 Non of the results of the samples tested were
conforming.
ّ .‫ّذيقعّنًائجّالعقـاتّاليتّخضعتّلؾػَصّمطابؼة‬
 Some of the results of the samples tested were non ّ .‫ ّذيقعّالعقـاتّاليتّخضعتّلؾػَصّبريّمطابؼة‬
conforming, mention them:
ّ ّ:‫ّاذكرها‬،‫ّبعضّالعقـاتّاليتّخضعتّلؾػَصّبريّمطابؼة‬
ّ

Evaluator's Notes: ّ :‫مالحظاتّمؼقمّالـًائج‬

ّ

Signature of Evaluator: ‫ ذ‬:‫توقوعذمقومذالنتائج‬

Date: ‫ذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذذ ذ‬:‫التاريخ‬
Review & Decision of granting/ denying the ‫ذ ذ‬:‫ذعدمذمنحذالشهادة‬/‫مراجعةذوقرارذمنحذالشهادة‬
certificate: ‫ذ‬

‫ ذ‬:‫التاريخ‬
‫ذ‬

Date:

3 ‫ من‬3 ‫صفحة‬ CTqf-093-01, rev.n