s-jet-pr51-02e-ed.2.4(Form 1-1/2)

Application for JET Certification
Date:
Receipt No.
(To be filled in by JET)

To Japan Electrical Safety & Environment Technology Laboratories

We hereby apply for Certification on the Product listed below, in order to obtain the Certificationas specified in the Rules for Operation of JET Certification.

１．Applicant
Company name:
Representative Job title:
Name:Address:

２．Product name
３．Model: (Please write all models. If necessary, please add an attached sheet.)
４．Factory: As shown in the separate sheet 1
５．Applied Standard for Testing: (Please tick the appropriate box below.)□ Description of the technical requirements by the METI Ordinance.
(APPENDIX□ Standard other than METI Ordinance(６．Application: (Please tick the appropriate box below.)□ New application□ Additional application (Certificate No.

Address
Section & Job title
NameFAX:))

７．Person in the charge of this application
Company nameTELEPHONE:)E-mail:s-jet-pr51-02e-ed.2.4(Form 1-2/2)
Receipt No.
(To be filled in by JET)

Separate sheet 1: List of the name(s) and address(es) of the Manufacturing Factory(Factories)
Attached documents: 1) Declaration of Technical Specification
2) Power of Attorney
3) Supplement to the Application for JET Certification and Points tobe confirmed
4) Descriptions on Quality control at the Factory (Factories)5) Description on Agreement on Commissioned production or Import
6) JET FACTORY INSPECTION REPORT SECTION B (If it is thefirst-time application for the factory)7) Application for Testing based on Procedures of Testing at
Manufacturer’s Premises (If such Testing is applied)8) CB Test Certificate (if Test Data are to be accepted under the CBscheme)s-jet-pr51-02e-ed.2.4(Separate sheet 1)
Receipt No.
(To be filled in by JET)

List of the name(s) and address(es) of the Manufacturing
Factory(Factories)〔Please be aware〕
Please enter all factories covered by the application.
・If it is the first-time application for the factory, please submit JET FACTORY INSPECTIONREPORT (SECTION B).
・If the factory is registered at JET, please enter the Factory Reference Number.
・If the factory is not in Japan, please make entries in English. Further, if it is in China or Taiwan,
please make entries both in English and in Chinese.
・If the manufacturing factories are more than 3, please attach an additional sheet.
Remark: If particular models are manufactured at the particular factory/factories, please describe
the detailed information on the distribution of the production.

(Examples)
Factory 1 (Factory Reference Number:
Name of the Manufacturer:
Name of the Factory:)

Address of the Factory: 〔zip code(postcode)〕(In Chinese)
Factory 2 (Factory Reference Number:
Name of the Manufacturer:
Name of the Factory:)

Address of the Factory: 〔zip code(postcode)〕(In Chinese)
Factory 3 (Factory Reference Number:
Name of the Manufacturer:
Name of the Factory:
Address of the Factory: 〔zip code(postcode))〕(In Chinese)
Remarks:
1. A Manufacturer is the organization that carries out the manufacturing, OK/NG judgment, handling,storage of the products, and supervises and controls all these activities, and, in doing so, bears
responsibility to have the products always conforming to the technical standards and assumes therelated obligation. (The Applicant may and may not be the Manufacturer.)
2. A Factory is the place at which the products are manufactured or assembled, and where the initial andfollow-up factory inspections are carried out by JET.

s-jet-pr51-02e-ed.2.4(Attached document 1)
Receipt No.
(To be filled in by JET)

Declaration of Technical Specification

１．

Product name:２．

Model and its rating: (Rated voltage, rated frequency, rated power consumption, etc.)(If they are not one, please write all combinations. If necessary, please add a sheet / sheets.)

３．

Technical information:(Please provide the product’s photos, drawings, the description on the casing materials,
component listings, circuit diagrams, markings, instruction manuals, and other informationnecessary to conduct the tests. If the space on this sheet is not sufficient, please attach thenecessary materials.)s-jet-pr51-02e-ed.2.4(Attached document 2)

Power of Attorney
Date: (m)

/(d)

/(y)

To. Japan Electrical Safety & Environment Technology Laboratories〔Applicant〕(Please enter “1. Applicant” of the Application for JET Certification)
Company name:
Address: 〔zip code(postcode)〕
Section, Job title:
Person in charge:(Signature or Seal)
I hereby entrust the following person as agent of the applicant with the application for JET Certification,and delegate full authority to him for making application, changing the entry/entries of the Certification, anddoing the related other procedures.
〔Agent〕
Company name:
Address: 〔zip code(postcode)
Section, Job title:
Person in charge:
Telephone:
E-mail:〕Fax:[Validity of this Power of Attorney] (Please tick the appropriate box below.)□ Till the change of the agent□ From//to//{(m) /(d) /(y)}Remark: If it is a new Power of Attorney, please submit the original. Next time onwards, please submit itscopy.

s-jet-pr51-02e-ed.2.4(Attached document 3 - 1/3)
Receipt No.
(To be filled in by JET)

Supplement to the Application for JET Certification and Points to be confirmed(Please tick the appropriate □)1.

Issue of Test Report□ Yes ( subject to fees) (□Simplified □Detailed) (□Japanese □English) version
Remark: If English version is to be issued, please give us the name and address of thecompany in English.
Please be forewarned that the restricted Test Report may be issued depending on
the content of the application.
□ No2.

Request for quick issue of the Certificate (subject to fees if the report is requested to be issued earlier
than in a month after the application.)□ Yes (by//{month/day/year})
□ No

3.

Is this your first application?
(Please enter the latest certificate number issued by JET below.)()

4.

Information on test samples (Please show shipping schedule, the number of cartons and othernecessary information below.)
Remark: Please note that JET is to inform the applicant how many samples are needed for the testing
after the content of the submitted documents is checked at JET’s section in charge.
If large samples are to be delivered to JET’s laboratory, please consult beforehand with thelaboratory□ Samples are to be shipped to JET on (//{month/day/year}) .
The number of packages:□ Samples are to be delivered to JET directly on (//{month/day/year}).
□ Other information: ()5.

Confirmation of the Addressee and other points)
１．

For inquiries, JET is to contact ;□Person in charge of this the application□Reference No. 1 below□Reference No. 2 below

２．

The Certificate and Test Report are to be sent to ;□Person in charge of this the application□Reference No. 1 below□Reference No. 2 below

The bill for testing fees and other related charges is to be sent to ;□Person in charge of this the application□Reference No. 1 below□Reference No. 2 below(If the bill is to be addressed not to the applicant, please write the addressee.)(Attached document 3 - 2/3)
３．

s-jet-pr51-02e-ed.2.4
Receipt No.
(To be filled in by JET)

４．
Return of the tested sample(s) ;□The tested samples are to be returned to (Carrying charges are to be collected on delivery):□Person in charge of this the application□Reference No. 1 below□Reference No. 2 below□The samples are to be picked up by the applicant.
□The samples are to be discarded by JET (Small-sized sample(s) only. The discarding
charges are to be borne by the applicant.)

Reference No. 1
Company name:
Address:
Section, Job title:
Person in charge:
Telephone:

Fax:

E-mail:Reference No. 2
Company name:
Address:
Section, Job title:
Person in charge:
Telephone:

Fax:

E-mail:6. Others (Messages if any)s-jet-pr51-02e-ed.2.4(Attached document 3 - 3/3)
Receipt No.
(To be filled in by JET)

【Points to be confirmed on the application for Certification】
１．This Application will come into effect after JET's receipt of the Test samples, necessary documents andthe estimated fees for Certification.
２．If the Test samples and necessary documents are not delivered to JET within six months after the datewhen JET verifies its receipt of this Application, this Application will be deemed to have been withdrawn
at the Applicant's request.
３．The Test samples shall be delivered to and received by Japan Electrical Safety & Environment
Technology Laboratories (Tokyo Lab., Yokohama Lab or Kansai Lab according to JET’s assignment).
The Applicant is responsible for the delivery.
４．If JET informs the Applicant of any defect or damage found in the Test samples delivered to JET, theApplicant shall immediately take countermeasures.
５．JET does not restore the original condition of the Test samples after the testing and does not bear
responsibility for any disassembly or damage of the Test samples which may have arisen as a result ofthe testing. Additionally, the number of packages may unavoidably increase or decrease whenreturning.
６．If the Applicant is to pick up the Test samples with which the testing was conducted, they are to bepicked up within 50 days after completion of the testing. If it is not done in time, the samples are at
JET’s disposal. In this case, the Applicant shall bear all expenses related to such disposal.
７．The Applicant agrees to allow JET’s staff members to enter the Manufacturing factories and perform
necessary investigations there if it is requested for the conduction of the Preliminary Factory Inspection.
８．The Applicant will be notified that an Initial Product Inspection will be conducted on products certified by
JET. In such case, the Applicant agrees not to ship any product labeled with the S-JET Mark until theresults of the initial lot inspection are available.
９．The Applicant agrees to observe the provisions of "Rules for Operation of JET Certification" and toprovide JET with all information necessary for evaluation of the product to be certified.
The Applicant has confirmed the above points on the Application for Certification.
□ Hereby I, the person in charge of the Application, accept the contents of all the above points to beconfirmed. (Please tick the box, if accepted)s-jet-pr51-02e-ed.2.4(Attached document 4)

Descriptions on Quality control at the Factory (Factories)
1. On receiving inspection and the storage of the inspection records
2. On the manufacturing and daily inspection of the products and the storage of the inspection records
3. On the check of functional operation of the measuring equipment and the carrying out of calibration,and on the storage of the records of checking and calibration
4. On the handling of the products
5. On the confirming inspection of the products and the storage of the inspection records
6. On the Quality system audit of the manufacturing factories
7. On the handling of nonconforming products
8. On complaints from customers and the storage of the records of the complaints
9. On the design control of the products to be certified
Remark: The above descriptions may be substituted by the explanation with diagrams, flowcharts or otherdocuments showing these series of particular charge.

s-jet-pr51-02e-ed.2.4(Attached document 5)

Descriptions on Agreement on Commissioned production or Import
Date:
Applicant name(Year/Month/Day)

These Descriptions are submitted in order to explain the contents of theAgreement on Commissioned production or Import, by which the manufacturing of thecertified products is commissioned to a business other than the Applicant (or the certified
products are imported from such a business), and under which the unified Quality Control
with such a business engaging in the production (manufacturing business, manufacturing
factory or the like) is carried out with definite accountability structure (designing,manufacturing and inspection and so on) and the certificate holder is assigned to evaluate its
maintenance and control.
1.

The name of the document in which the Agreement on commissioned production or importis embodied and the date of its conclusion

2.

The document on commissioned production or import has the following contents.
Remark: the following descriptions may be substituted by the explanation with diagrams,
flowcharts or other documents showing these series of particular charge.
1) Description on accountability structure in Quality Assurance under the unified Quality
Control (The burden sharing under the accountability structure shall be explicit.)(Example) The following accountability structure is described.
Manufacturer: Product design, Quality assurance, Observance of test
standards
Manufacturing factory : Production Control, Product inspection, Confirmation ofconformity to test standards
Certification holder : Verification of the Quality Control over the products(Recording of Design changes, Products inspections andso on).
2) Description on implementation of Quality Control over the products at the manufacturing
factory/factories (Receiving Inspection / Production Inspection / Delivery Inspection /Sampling Inspection)(Example) The corresponding regulations have been set up and the implementation ofQuality Control over the products is described.
3) Description on the procedure for the certification holder to verify of Quality Control overthe products(Example) Periodical submittal of the records of Delivery Inspection is described.
4) Description on the obligation to conform to the Test Standard applied for the Certification(Example) The obligation to conform to the applied Test Standard is described.

s-jet-pr51-02e-ed.2.45) Description on the control of S-JET Certification Mark(Example) It is described that the S-JET Certification Mark can be placed only on thecertified products.
6) Description on the follow-up factory inspections of the manufacturing factory / factories(Example) It is described that the follow-up factory inspection is carried out once a yearby JET or by the inspector JET entrusts.
7) Description on the handling of S-JET Certification Mark : if the design of the certified
product is changed, the notice of Design Change shall be submitted to JET for thereview for the continued Certification, and S-JET Certification Mark shall not be placedon the changed models without JET’s approval(Example) It is described that if the design of the certified products is changed, JET is tobe informed of it beforehand.
8) Description on the observance of the Agreement on JET Certification(Example) It is described that the copies of the Agreement on JET Certification are to begiven to the Manufacturer and the Manufacturing Factory / Factories and the provisionsof the Agreement on JET Certification are to be observed.

The above statement is true and correct.
ApplicantCompany name:
Section and Job title:
Person in charge of Certification of the products:(Signature or Seal)

Manufacturer
Company name:
Section and Job title:
Person in charge of Quality Control:(Signature or Seal)

Manufacturing factory
Company name:
Section and Job title:
Person in charge of Quality Control:(Signature or Seal)s-jet-pr51-02e-ed.2.4(Attached document 7)

Receipt No.
(To be filled in by JET)

Application for Testing based on Procedures of Testing at
Manufacturers’ Premises
To Japan Electrical Safety and Environment Technology Laboratories

Hereby we apply for testing of the products stated hereunder at the manufacturer’s premises.

１．

Applicant for Certification:
Company name::
Address : 〔Zip code (postcode)〕２．

Product name :３．

Models of the Product: (Please write all models. If necessary, please add an attached sheet.)４．

Reason for this Application:

５．
Place for the Testing: (Please give an approximate time required from the nearest station andattach a diagrammatic sketch showing directions.)

６．

Request for date of the Testing:７．
Person in the charge of this application
Company name
Address
Section & Job title
Name
TELEPHONE:(Signature or seal)
FAX:

E-mail: