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PI Application Form Certification PROFIBUS Apr23

This document is an application for a PROFIBUS certificate to certify PROFIBUS products. It requests information about the applicant and device, and selection of certification options including fees. It must be signed and includes a test report submission.

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trifa.razvan22
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36 views1 page

PI Application Form Certification PROFIBUS Apr23

This document is an application for a PROFIBUS certificate to certify PROFIBUS products. It requests information about the applicant and device, and selection of certification options including fees. It must be signed and includes a test report submission.

Uploaded by

trifa.razvan22
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PROFIBUS Nutzerorganisation e.V.

(PNO)
A member of PI (PROFIBUS & PROFINET International)
[email protected] Send Email

Print

Application for a PROFIBUS Certificate


Certification of PROFIBUS products is strongly recommended
We herewith apply for a PROFIBUS Certificate based on the quality documents “Framework for
Testing and Certification of PROFIBUS and PROFINET Products” and “How to get a Certificate
for PROFIBUS/PROFINET Device”, the PNO Trademark Statues as well as the relevant Test
Specifications. The Certificate is issued in English. We agree that it will be published on the PI
Website.

Applicant:
(Fill in precisely.)
Vendor Name: _______________________________________________________
Contact Person: __________________ Department: _________________________
Phone: _________________________ Fax: _______________________________
Street: _____________________________________________________________
ZIP-Code: ______________________ City: ________________________________
Email-Address: ______________________________________________________

Device Description:
(Will be printed on certificate. Indications printed in test report are binding.)
Model Name: ________________________________________________________

Revision/Release: ____________________________________________________
Ident Number: ________________________________________________________
Enclosure: Test Report of Authorized Test Laboratory:
(Submit PDF of test report via email to [email protected].)
Number: _________________________ Date: ______________________________
Test Laboratory: ______________________________________________________
Certification:
□ First-time certification for this product (fee € 6,000 (plus VAT) for non-members)
□ Update of an existing with re-test (fee € 3,000 (plus VAT) for non-members);
Certificate Number: ______________
□ Update of an existing certificate without re-test (no fee);
Certificate Number: ______________

□ We are a Member of PI in ___________________________________ (enter your RPA).


The certificate will be granted without any charges.
□ We are no Member of PI, we will pay the applicable fee after receiving
an invoice. Our VAT-No is: ______________________________(only european customers)

Legally binding
Date, Place: Signature:
PROFIBUS Nutzerorganisation e.V.
Vereinssitz / Location of the Association: Ohiostraße 8, 76149 Karlsruhe, Deutschland / Germany; Amtsgericht / Local Court Mannheim; Register-
Nr. / Reg-No.: VR 102541; Vorstandsvorsitzender/Chairman of the Board of Directors: Xaver Schmidt; Vorstand/Board of Directors: Frank Moritz,
Prof. Dr. Felix Hackelöer, Harald Müller; USt-ID-Nr. / VAT Ident No.: DE123383230; Bankverbindung / Bank Account: BW-Bank, BLZ: 600 501
01, Kto.-Nr. / Account No.: 749 550 484 6, IBAN: DE04 6005 0101 7495 5048 46, BIC: SOLADEST600

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