The Hong Kong Standards and Testing Centre Ltd 香港標準及檢定中心
香港總公司 : 香港大埔工業村大宏街10號 電話 Tel : +852 2666 1888 傳真 Fax : +852 2664 4353
HK Headquarters: 10 Dai Wang Street, Tai Po Industrial Estate, Tai Po, HK
東莞公司: 中國廣東省東莞市大朗鎮富民南路68號 郵編：523770 電話 Tel : +86 769 8111 9888 傳真 Fax : +86 769 8111 6222
Dongguan office: No. 68 Fuminnan Road, Dalang, Dongguan, Guangdong, China Zip Code: 523770

Chemical and Food Department
APPLICATION FOR Food-Contact Article Testing (Non-ceramic) 食品接触品試験依頼書 (非セラミック) CFD/888/04ceRev.12
For Office Use

Applicant /会社名（英字ブロック体）

Address 住所:

Application No.:

Customer No.:

Received :Committed :Reviewed By :Contact Person

Email :

Date :

Tel :

Fax :

担当者 :
Payer Name 支払い:

Company Name and Address shown on Test Report: (if different from the Applicant Name above)
報告書に記載する会社名と住所が異なる場合：

Same as Applicant 申請者

Please specify if different 申請者以外:

Sample Name / 検体試料名称 :Buyer / バイヤー :Consignment No. 委託番号.:
Style / Item No / 製品番号.:
Country of Origin / 原産地 :

Other information to be shown on test report / 報告書に記載するその他情報:
Test Required / 試験項目：
Plastic food contact articlesプラスチック製食品容器
EU Food Grade 欧州食品接触規制(#Must provide below information) (以下情報提出)
Overall migration
Specific migration of:#Use Mode 使用方法
Repeated Use 反復使用

Single use使い捨て

Conditions of food contact 食品接触条件:#Contact Food Types 食品接触種類:
Aqueous 水溶性

Acidic 酸性

Alcoholicアルコール性:

≤20%

>20%

Fatty foods 脂肪食品
Only Contact Milk, fermented milk, cream and sour
cream 牛乳、発酵乳、クリーム、サワークリーム#Contact Temperature 食品接触温度:
T≤5C
5C<T≤20C
20C<T≤40C
40C<T≤70C
70C<T≤100C
100C<T≤121C
121C<T≤130C
130C<T≤150C
150C<T≤175C
T>175C#Contact Time 食品接触時間t≤5min5min< t≤0.5h
0.5h<t≤1h
1h<t≤22h<t≤6h
6h<t≤24h1d<t≤ 3d
3d<t≤ 30d
storage up to 6m>6m
FDA Regulations 米国食品医薬品局規制
EVA, 21 CFR 177.1350
MF, 21 CFR177.1460
Nylon, 21 CFR 177.1500
PE
PP
PPCo : 21 CFR 177.1520
PC, 21 CFR 177.1580
PET, 21 CFR 177.1630
Service Required / 緊急依頼* :Regular 通常

Country of Destination / 仕向国 :PS, 21 CFR 177.1640
POM, 21 CFR 177.2470
Rubber, 21 CFR 177.2600
Perfluorocarbon resins, 21 CFR 177.1550
ABS, 21 CFR 180.22
Resinous and polymeric coating,
21 CFR 175.300
Other :
Japan Food Sanitation Law for Container –Malaysia FoodAct&Regulation マレーシア食品法- Leachable Lead, Cadmium, Antimony & Arsenic
Microwave safe BS EN 15284 : 2007
Dishwasher safe BS EN 12875-4 : 2006
Non-plastic / Non-ceramic Food Contact Article

Packages 食品衛生法 容器包装
Synthetic resins made from formaldehyde
Polyvinyl chloride (PVC)
Polyethylene (PE)Polypropylene (PP)Polystyrene (PS)
Nylon (PA)Polyvinylidiene chloride (PVDC)
Polyethylene terephthalate (PET)Polymethyl methacrylate (PMMA)
Polysmethyl pentene (PMP)
Rubber (except nursing utensils)
Rubber (nursing utensils)
Other :

アメリカ FDA Regulations - 21 CFR 176.170

Germany Standard, LFGB ドイツ容器包装
ABS
Polyvinyl chloride (PVC)
Polyethylene (PE)Polypropylene (PP)Polystyrene (PS)
Nylon (PA)Polyoxymethylene (POM)
Melamine
Acrylic
Polyurathene (PU)Silicone
Other :

非プラスチック非セラミック食品容器
Paper 紙製
ドイツLFGB中国 GB11680-89
Metal 金属製
日本 Japan Food Saintation Law for Container –Metal Can 金属缶
ドイツ LFGB- Stainless Steel and metal alloy
ステンレス/金属合金- Aluminium アルミニウム
BSEN 601- Casting aluminium alloys
鋳造アルミニウム合金
BSEN 602- Wrought aluminium alloys
鍛造アルミニウム合金
Wood 木製
ドイツ LFGB

Korean Standard 韓国容器包装
ABS / AS
Polystyrene (PS)Polyethylene terephthalate (PET)Melamine-formaldehyde (MF)
Other :

- Pentachlorophenol ペンタクロロフェノール

Priority 至急(40% Surcharge)

Immediate緊急(100% Surcharge)

木材用防腐剤, 21 CFR 178.3800
Other tests その他試験 (下記に記載) :*Sample pick-up time not included / 試料の輸送にかかる時間は含まれません

Test Report 試験報告書︰

PDF Report

Hard Copy (Return Untested Remain Samples 未使用試料の返送︰

Self Pick-u 自社受取
Yes 要

Tai Po Head Office 本社受取

Mail 郵送/ Courier 速達**

No Need to Return Sample 不要^ Please understand all tests are destructive tests. Samples will be damaged and are not recoverable. Otherwise, sample submitted for testing will be scrapped at the discretion of STC uponcompletion of the test. ご提供いただいた試料は試験により破損し、復元不可となります。また試験に使用した試料は試験完了後、STCの判断により廃棄いたします。
** Service charge may be levied if reports or samples are to be returned by mail / courier 報告書または試料の返品にかかる配送料は自費負担となります。

I, hereby, confirm my agreement to the Terms and Conditions contained in this form (also available at https://www.stc.group) as a condition forthe contract with The Hong Kong Standards and Testing Centre Ltd. Prior to this confirmation, I have been briefed with such Terms andConditions to my understanding and was given opportunities to raise question, if any.
私はこの申請書に含まれるThe Hong Kong Standards and Testing Centre Ltdの利用規約（https://www.stc.group）に基づいて理解した上で同意し署名いたします。質問がある場合は提起する機会が与えられます。
Authorized signature and company chop of the applicant /会社代表者の署名と社印:(Test requisition without authorized signature and company chop will not be accepted)(無授權代表人簽名及公司蓋章的申請表將不會受理)
Printed Name /担当責任者:
Job Title / 役職:
Date / 日付 :1/3

(英字ブロック体)

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GENERAL CONDITIONS OF TESTINGTHE HONG KONG STANDARDS AND TESTING CENTRE LTD., (the "Centre"), while reserving the right to decline, without giving any reason whatsoever, any request for the undertaking
of a test or investigation, will carry out at the request of the clients the required test or investigation subject always to the following conditions: 1. The Centre only acts for the person or body originating the instructions (the "Applicant"). No other party is entitled to give instructions, particularly on the scope of testing or delivery ofreport or certificate, unless authorized by the Applicant.
2. All materials, equipment and other property to be tested or investigated shall be delivered at the costs of the Applicant and in accordance with the requirements of the Centre. At theconclusion of the test or investigation, the Applicant shall, if required by the Centre, collect the materials or equipment. In any event, if the materials or equipment are not collected by the
Applicant within 30 days from the issuance date of the test report (for perishable items such as food and water samples, the relevant period shall be 7 days), the Centre may at its discretion
dispose of the same without any compensation to the Applicant.
3. The Applicant shall always comply with the followings before or during the Centre providing its services:(a) give timely instructions and adequate information to enable the Centre to perform the services effectively;(b) supply, when requested by the Centre, any equipment and personnel for the performance of the services;(c) take all necessary steps to eliminate or remedy any obstruction in the performance of the services;(d) inform the Centre in advance of any hazards or dangers, actual or potential, associated with any order of samples or testing;(e) provide all necessary access for the Centre's staff and/or representative(s) to enable the required services to be performed effectively;(f)ensure all essential steps are taken for safety of working conditions, sites and installations during the performance of services;(g) fully discharge all its liabilities under any contract like sales contract with a third party, whether or not a report or certificate has been issued by the Centre, failing which the Centre
shall be under no obligation to the Applicant.
4. Subject to the Centre's accepting the Applicants’ instructions, the Centre will issue reports and certificates which reflect statements of opinion made with due care within the scope of
instructions but the Centre is not obliged to report upon any facts outside the instructions. The Applicant shall always render adequate and accurate information and particulars of the test
sample to the Centre, failing which the Centre shall not be responsible for any faults and/or mistakes on the certificate and/or reports in relation thereto.
5. The Centre is irrevocably authorized by the Applicant to deliver at its discretion the report or the certificate to any third party when instructed by the Applicant or where it implicitly follows
from circumstances, trade custom, usage or practice as determined by the Centre.
6. A test report will be issued in confidence to the Applicant and it will be strictly treated as such by the Centre. It may not be reproduced either in its entirety or in part and it may not be used
for advertising or other unauthorized purposes without the written consent of the Centre. The Applicant to whom the Report is issued may, however, show or send it, or a certified copy
thereof prepared by the Centre, to his customer, supplier or other persons directly concerned. Subject to Clause 7, the Centre will not, without the consent of the Applicant, enter into any
discussion or correspondence with nor disclose to any third party concerning the contents of the report unless required by the relevant governmental authorities, laws or court orders.
7. The Centre shall be at liberty to disclose the testing-related documents and/or files anytime to any third-party accreditation and/or recognition bodies for audit or other related purposes
unless disagreed with by the Applicant in writing at the time of them submitting the applications. No liabilities whatsoever shall attach to the Centre's act of disclosure.
8. Notwithstanding anything contained herein to the contrary, but subject to Clause 7, it is agreed that the Centre will be responsible for the management of all confidential information ofApplicant obtained or created during the performance of laboratory activities:(a) The Centre will inform the Applicant in advance, of the information it intends to place in the public domain. Except for information that the Applicant makes publicly available, or whenagreed between the Centre and the Applicant (e.g. for the purpose of responding to complaints, or situations set off in Clause 7), all other information is considered proprietary
information and shall be regarded as confidential.
(b) When the Centre is required by law or authorized by contractual arrangements to release confidential information, the Applicant or individual concerned will, unless prohibited bylaw, be notified of the information provided.
(c) Information about the Applicant obtained from sources other than the Applicant (e.g. complainant, regulators) shall be confidential between the Applicant and the Centre. The
provider (source) of this information will be confidential to the Centre and will not be shared with the Applicant, unless agreed by the source.
(d) Personnel, including any committee members, contractors, personnel of external bodies, or individuals acting on the Centre's behalf, will keep confidential all information obtainedor created during the performance of laboratory activities, except as required by law.
9. The Applicant wishing to use the Centre's reports in court proceedings or arbitration shall inform the Centre to that effect prior to submitting the sample for testing.
10. The report will refer only to the sample tested and will not apply to the bulk, unless the sampling has been carried out by the Centre and is stated as such in the Report.
11. When a statement of conformity is provided in the report, the Centre will adopt a decision rule as described below:(a) Non-numerical results (e.g. pass-fail outcome of a test procedure or the result of applying a go or no-go gauge etc.):
 A statement of conformity will be reported directly according to the test result and the specification.
(b) Numerical results:
i. when testing to the following standards / specifications, determination of conformity will follow the decision rule prescribed in the respective legal / regulatory requirements:
 Nil.
ii. when testing to the following standards / specifications, determination of conformity will follow the decision rule which is inherent in the respective standards / specifications: ISO 8124-3, AS/NZS ISO 8124-3, ASTM F963 clause 4.3.5.1(2) and 4.3.5.2(2)(b), GB6675-4, Japan ST2016 clause 1.5, 1.8 and 1.11, Japan Food Sanitation Law clause A4
and A11;
 EN 62233, IEC 60601-1;
 ICES-001, IECS-003, IECS-005, CISPR 13, CISPR 14-1, CISPR 15, CISPR 22, CISPR 32, EN 55013, EN 55014-1, EN 55015, EN 55022, EN 55032, EN 61204-3, EN 62493,
GB/T 13837, GB/T 9254, GB/T 17743;
 EN 1811, EN 1186.
iii. when testing is conducted under IECEE CB Scheme, guidance provided in IEC Guide 115 will be followed for the determination of conformity.
iv. when testing to EMC standards / specifications other than that listed in 11(b)(i)~(iii), determination of conformity will follow the decision rule: Pass: The measured result is within the tolerance interval minus the guard band (w), where w equals to expanded uncertainty with 95% coverage probability.
 Fail: The measured result is outside the tolerance interval plus the guard band (w), where w equals to expanded uncertainty with 95% coverage probability.
 Unable to determine conformance - The measured result is within the guard band (w), which equals to expanded uncertainty with 95% coverage probability.
v. when testing to the standards / specifications other than that in 11(b)(i)~(iv) above, determination of conformity will follow the decision rule: For specification with upper limit, compliance is deemed to occur if the measured result is under the limit, even extended upwards by the expanded uncertainty with 95% coverage
probability.
12. For specification with loAny documents containing engagements between the Applicant and third parties like contracts of sale, letters of credit, bills of lading, etc. are regarded as
information for the Centre only and do not affect the scope of the services or the obligations accepted by the Centre.
13. If the Applicant do not specify the methods / standards to be applied, the Centre will choose the appropriate ones and further information regarding the methods can be obtained by directcontact with the Centre.
14. No liability shall be incurred by and no claim shall be made against the Centre or its servants, agents, employees or independent contractors in respect of any loss or damage to any suchmaterials, equipments and property occurring whilst at the Centre or any work places in which the testing is carried out, or in the course of transit to or from the Centre or the said work
places, whether or not resulting from any acts, neglect or default on the part of any such servants, agents, employees or independent contractors of the Centre.
15. The Centre will not be liable, or accept responsibility for any loss or damage howsoever arising from the use of information contained in any of its reports or in any communication
whatsoever about its said tests or investigations.
16. Subject to Clauses 14 and 15, the total liability of the Centre in respect of any claim of loss, damage or expense of whatsoever nature shall not exceed a total sum equal to five times theamount of the service fee payable in respect of the services directly related to such claim, and the Centre's liability shall not include any indirect, special or consequential loss of the
Applicant.
17. In the event of the Centre prevented by any cause outside the Centre's control from performing any service for which an order has been given or an agreement made, the Applicant shall
pay to the Centre:i) the amount of all abortive expenditure actually made or incurred; andii) a proportion of the agreed fee or commission equal to the proportion (if any) of the service actually carried out by the Centre.
and the Centre shall be relieved of all responsibility whatsoever for the partial or total non-performance of the required service.
18. The Centre shall be discharged from all liability for all claims for loss, damage or expense unless suit is brought within one calendar year after the date of the performance by the Centreof the service relating to the claim or in the event of any alleged non-performance within one year of the date when such service should have been completed.
19. The Applicant acknowledges that the Centre does not, either by entering into a contract or by performing service, assume or undertake to discharge any duty of the Applicant to any otherpersons. The Centre is neither an insurer nor a guarantor and disclaims all liability in such capacity.
20. The Applicant shall hold harmless and indemnify the Centre and its officers, employees, agents or independent contractors against all claims made by any third party for loss, damage or
expense of whatsoever nature including reasonable legal expenses relating to the performance or non-performance of any services to the extent that the aggregate of any such claims
relating to any one service exceed the limits mentioned in Clause 16.
21. In the event of improper use of the report, the Centre reserves the right to withdraw it, and to adopt any other measures which may be appropriate.
22. Samples submitted for testing are accepted on the understanding that the report issued cannot form the basis of, or be the instrument for, legal action against the Centre.
23. Samples are deposited with and accepted by the Centre on the basis that either they are insured by the Applicant or the Applicant assumes entire responsibility for loss through fire, theft,
burglary or for damages arising in the course of analysis or handling, without recourse whatsoever to the Centre or its servants, agent, employees or independent contractors.
24. If the requirements of the Applicant require the analysis of samples by the Applicant’s or any third party's laboratory, the Centre will only convey the result of the analysis without
responsibility for its accuracy. If the Centre is only able to witness an analysis by the Applicant’s or any third party's laboratory the Centre will only confirm that the correct sample has
been analyzed without responsibility for the accuracy of any analysis or results.
25. In the event of any unforeseen additional time or costs being incurred in the course of carrying out any of its services, the Centre shall be entitled to charge the Applicant additional fees
to reflect the additional time and costs incurred.

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26. All rights (including but not limited to copyright) in any reports, certificates or other materials produced by the Centre in the course of providing its services shall remain vested in theCentre.
27. The Applicant shall punctually pay on the date of invoice or within such other period agreed in writing by the Centre all charges rendered by the Centre or interest will become due at therate of three per cent per month from the date of invoice until actual payment. The Applicant is also responsible for settling all the Centre's costs of collecting the charges owed, including
legal fees.
28. Test results may be transmitted by electronic means at the Applicant's request. However, it should be noted that electronic transmission cannot guarantee the information contained will
not be lost, delayed or intercepted by third party. The Centre is not liable for any disclosure, error or omission in the content of such messages as a result of electronic transmission.
29. If necessary, the Centre may subcontract part of or all tests to competent subcontractors. If no objection is raised at the time of the Applicant submitting the application, the Centre shallassume the Applicant's approval.
30. The Centre reserves the right to include Special Conditions in addition to the foregoing General Conditions if warranted by the particular circumstances of the required test or investigation[this clause is only effective when the other party has been informed].
31. For any dispute, controversy or claims arising out of relating to this contract, or the breach, termination or invalidity thereof between the Centre and the Applicant, these terms andconditions shall take precedence over any other terms and conditions previously agreed to by the parties or the agent or representative of either parties.
32. The foregoing General Conditions shall be governed and construed according to the laws of Hong Kong Special Administrative Region. Any dispute shall be conclusively settled underrules of arbitration of the International Chamber of Commerce by one or more arbitrators appointed in accordance with the said rules. Unless otherwise agreed, the arbitration shall takeplace in Hong Kong.

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