THIS COMPLETED FORM REMAINS WITH THE SUPPLIER AS PART OF THE DOCUMENTATION REQUIRED FOR THE “COMPLIANCE FOLDER” DO NOT SUBMIT THIS FORM TO THE MINISTRY.
Supplier’s Details
Name (of New Zealand manufacturer, importer or agent)
Address (Street, Suburb, City)
Trading Name (if different)
Postcode
New Zealand Company Number (if applicable)
Contact Information
Telephone
Postal Address
Fax
E-mail
Product Details
Brand Name
Type and Model
Description and Function
Applicable Standard
Supplier Identification (as affixed to product)
Supplier Code Number (SCN); or
Registered Name and Address; or
Registered Company Number; or
Registered GST Number; or
Registered Trademark; or
Declaration
I declare that the product complies with the standard specified, and that all products to be supplied under this Declaration will be identical to that product.