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Supplier(Manufacture/Importer) Declaration of Conformity

This form shall be filled in on the company’s official papers.

1. Supplier’s Details:
Name:
Address:
Contact Person:
E-mail:
Tel.:
Fax:
2. Product Details: Lubricant Oil
Product’s Trademark: Kixx HD1
Type/Model: L2015AL1E1
Product Description:
Class/type (as per specifications): /
Level: /
Category: Type 3
Reference Standards/Technical Specifications: Lubricants & oil

We, hereby, acknowledge that the product above mentioned in this declaration is in
conformance with the Saudi technical regulation (Technical regulation for lubricants
& Oil) and the Saudi standards attached thereto.

Person in Charge:
Company Name:
Signature:
Date: 31.05.2022

F35-1 Rev.01 Aug 25, 2021 1 of 1

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