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SD-SCD-QF15 Application for Extension/ Reduction in of Scope in Certification

DTI BPS application/ reduction form for extension and reduction of scope in certification

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No.
Revision No.

SD-SCD-QF15
3

Effectivity Date:
Page

01 May 2016
1 of 1

BPS PRODUCT CERTIFICATION SCHEME
Application for Extension / Reduction in the Scope of
PS CERTIFICATION

CERTIFIED

CERTIFIED

Product Quality

Product Safety

Date: ________________
The Bureau Director
Bureau of Philippine Standards
Department of Trade and Industry
3/F, Trade and Industry Building
361 Sen. Gil J. Puyat Avenue
Makati City
Sir:
In accordance with Department Administrative Order No.4:2008 and its future amendments, promulgated pursuant to Section 79 (B) of
the Revised Administrative Code of the Philippines and Executive Order No. 101, Series of 1967, in conjunction with the provisions of R.A. 4109
and R.A. 7394, we hereby apply for extension/reduction in the scope of the Philippine Standard (PS) Quality and/or Safety Certification Mark.
CHANGES/
UPDATE
COMPANYPROFILE

YES

NO

Company’s Registered Name
Complete Plant Address
PS License Number
Telephonenumbers
Facsimile numbers
Email address
President/ General Manager
Quality Management Representative
Deputy Quality Management Rep.
Product
Product Standard
Specific model/type/sizes applied for :
 Extension
 Reduction
(For DTI use only)

In the event the application is granted, we hereby agree to abide by all terms
and conditions thereof and all other rules and regulations, including amendments
thereto, prescribed for its use.
IN WITNESS WHEREOF, I have hereunto set my hand this ___________ day of
_______20__ at______________, Makati, Philippines.

________________________
Print Name and Signature
(President/General Manager)
SUBSCRIBED
AND
SWORN
to before me this
_____day of
_________________20__, Affiant exhibited to me his/her residence certificate no.
____________________
issued
at
_________________
on
______________________.

NOTARY PUBLIC
Doc. No. __________
Page No. __________
Book No. __________
Series of __________

EVALUATION AND RECOMMENDATION
 for INCLUSION to PS License subject to satisfactory
result of:
 QMS Audit
 Product Audit
 Sampling
 Independent test
 Verification
 for REDUCTION from PS License
 Others _____________________
Remarks: ____________________________________
____________________________________
Evaluated and Recommended by:
______________________
Product Certification Officer

Note: If the PS applicant is foreign, this application shall be authenticated by the Philippine Embassy that covers the plant location.
 
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