GLOBALPLATFORM SESIP CERTIFICATION BODY REQUEST FORM
Date:
To:
GlobalPlatform Security Evaluation Secretariat
Email: security-certification@globalplatform.org
New Request
Update (for update, please provide CB identification and updated data only)
SESIP Levels 1, 2 and 3 and/or
SESIP Levels 4 and 5I.

General CB and Facility Information

Certification Body Legal Name(“CB”)
State/Country of Incorporation
Address of Registered Office
Entity Type (corporation, trust,partnership, government, etc.)
Registration Number
Address of specific CB facilityfor which licensing is beingsought (the “Facility”)Please identify any superior orsubordinate business
relationships, e.g. with a parent
company or subsidiaries
Is there any conflict of interest inregards to CB
ownership/shareholding andyour vendor customers or
accredited laboratories?
Provide an organizational chart
for the CB including generalmanagement, technical andquality Personnel.
“Personnel” includes CB’s own
staff and contractors (ifapplicable).
Provide the list of Laboratories
accredited/licensed for therequired SESIP Levels and forother security schemes operated
by the CB.
Does the CB have audited
financial reports and theequivalent of a Dun & Bradstreet
report?

Please indicate if multiple facilities are concerned andprovide their address and registration status
Please clarify shareholding structure

Please attach (for each Facility)

For each Lab, please indicate the validity of the ISO
17025 accreditation.

Please attach, if available

Provide an Executive andFinancial Summary of the CB for
the last 3 years
Does the CB have adequate
insurance per GlobalPlatform
Security SESIP CB Relationship
Agreement, covering thecompany and each facility forwhich licensing is being sought?
Is the CB currently a party to acontract with GlobalPlatform orany of its Members? Pleaseexplain.
Provide the GlobalPlatform
membership status and the listof Committees and Working
Groups the CB is involved in.
II.

Please Attach

Accreditation status

ISO 17065:2012 accreditation
status, scope and validity date

Please attach ISO 17065 accreditation notice including
technical scope and authorized Personnel.
Please indicate if the use of contractors is covered by theISO accreditation.
Please indicate which are the schemes that aremanaged according with ISO 17065:2012 procedures.

List any accreditation or
licensing from otherorganizations, to the extent
relevant to the Facility and its
operationsIII.

Please attach all other relevant accreditation/licensing
notice(s) including technical scope(s) and authorized
Personnel.

CB Expertise and Experience

Provide a description of theCB’s background in security
certification to the extent
relevant to the Facility andits operations

For SESIP Levels 1-3, demonstrate capacity to assess
evaluation laboratories for IoT platform evaluation at
AVA_VAN.3 (Enhanced-basic attack potential) or higher.

For SESIP Levels 4-5, demonstrate capacity to assess
evaluation laboratories for IoT platform evaluations at
AVA_VAN.5 (High-attack potential).
Provide the Common
Criteria expert groups theCB is involved in.
Describe the technicalexpertise and experience of
the CB’s Personnel involvedin the SESIP scheme.

Please attach the CV of all the CB’s Personnel that isexpected to perform SESIP certification at the required
Level(s).

Provide the list ofcertification projects (*) in
relationship with therequested SESIP Level(s)for the last 3 years.
(*) GlobalPlatform reserves the right to require access to these projects as part of anorganizational and technical oversight procedure.
IV.

CB Contact Information

Officer of the CB who will sign all agreements with GlobalPlatform
First Name
Last Name
Title
Mailing Address(if different from registeredaddress)
Contact for Legal Notices
First Name
Last Name
Email Address
Mailing Address(if different from registeredaddress)
Telephone Number (Office)Facsimile Number
Primary Contact for all Communication regarding the operation of SESIP scheme
First Name
Last Name
Email Address
Mailing Address(if different from registeredaddress)
Telephone Number (office)Mobile Phone Number
Facsimile Number
Primary Contact for all Financial Communications and Invoices
First Name
Last Name
Email Address
Mailing Address(if different from registeredaddress)
Telephone Number (office)
Mobile Phone Number
Facsimile Number
I respectfully request that “CB” be considered as a candidate for a Licensed
GlobalPlatform SESIP Certification Body for the selected Levels with respect to thespecific CB Facility identified above.
Sincerely,
Officer Name:
Title:
Signature_____________________________________