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1、 进口矿用产品安全标志延续申请书Mining Products Safety Approval Application Form For Extension申 请 单 位：(盖章)Application Company :_(stamp)填 报 日 期：年 月 日 Submission date: xx/xx/xx/ (year/month/date) 安标国家矿用产品安全标志中心制Mining Products Safety Approval and Certification Center 申请与填表说明 Read me before fill the form1. 已取得的进口矿用产品安
2、全标志到期前六个月需提交延续申请。Need to submit the Safety Approval Application Form For Extension to our center in 6 months ahead of expire end. 2延续申请的产品技术文件、主体资格若无变更，应提交无变更说明；Need to submit the NO CHANGE letter if there is no major changing in product technical documents and applicant qualification.3. 延续申请的主体资格若发
3、生变更应在表中相关栏目进行填写，并提交变更说明及变更后的相关文件。Need to submit the Qualification Change letter specify what has been changed、 the updated documents after changing and fill the form next pages if there are changes in qualification of application company. 4. 延续申请的产品技术文件若发生变更应在表中相关栏目进行填写，并提交产品变更前后的差异性说明及变更后的技术文件。Need
4、 to submit the Technical Change letter specify the differences、 the updated technical documents after changing and fill the form next page if there are changes in technical documents. 表1：延续产品登记表Register Table of Products for Extension序 号No产品名称Name of Product型号规格Model执行标准Conducting Standards安全标志编号App
5、roval No 有效期Expires End有无变更Changes or Not 1 表2：申请单位基本情况及技术文件登记表Application Company Information & Technical Documents Table 事项Items有无变更Changes or not实际情况Statues 注册登记信息Register Information名称 Name原(former one)：现(updated one)：住所（地址）Address原(former one)：现(updated one)：负责人 Responsible Person原(former one)：
6、现(updated one)：注册资金 Registered Capitals原(former one)：现(updated one)：技术文件Technical Documents产品标准 Product Standards原(former one)：现(updated one)：产品设计（图）Design Drawings产品说明书 Products Operation Manual 备注Notes表3：委托联系单位基本情况表Authorized Agency Information事项Items有无变更Changes or not实际情况Statues 单位名称 Name 原(forme
7、r one)：现(updated one)：单位地址/邮编 Address/Postcode原(former one)：现(updated one)：单位负责人 Responsible Person原(former one)：现(updated one)：营业执照注册号 Business Register No原(former one)：现(updated one)：注册资金（万元） Registered Capitals (ten thousand)原(former one)：现(updated one)：安标联系人及联系方式Contact Person in Our Center and
8、Contact No电话Tel(固话)Office:(移动)Mobile:电子邮箱 E-mail Address备 注Note:表4申请单位承诺Commitment From The Manufacturer（一） 遵守矿用产品安全标志管理相关规定；Comply with the Mining Products Safety and Approval Regulation.（二） 提交的申请材料真实有效，并在矿用产品安全标志中心备案；Ensure all submitted documents is real and valid, all documents will be filed in
9、our center. （三） 接受并积极配合技术审查、现场评审、产品检验等工作, 接受有关矿用产品安全标志的监督检查；Accept and cooperate the technical review、factory audit and products test, accept the supervision and inspection by our center. （四） 保证产品执行的标准即为在安全标志中心备案的技术文件；Ensure the production standards implemented in the plant conform to the documents
10、filed in our center.（五）保证产品质量合格； Guarantee the quality of the products；（六）按规定使用安全标志标识； Ensure using the safety logo properly;（七）接受违反安全标志规定的相关处罚及承担法律责任;Accept the penalties and legal obligation if manufacturer against the relevant mining product safety regulation； （八）承担申办及监督管理的相关费用。Accept the applica
11、tion fee and associated costs from supervision and management; 制造商签章：Manufacturer StampNote: Chop Stamp should be the manufacturer who produces the products, not the agent or other parties.通讯地址：北京和平里青年沟路5号煤科总院内（100013）联系电话：010-84264266/811/815网 址：www.aqbz.orgAddress: Mining Products Safety Approval and Certification CenterChina Coal Research InstituteNo5 Qing Nian Gou Rd，He Ping Li，Beijing（100013） Tel: 010-84264266/811/815Website Address: www.aqbz.orgAll right reserved: Mining Products Safety Approval and Certification Center7
