CONSTRUCTIONAL DATA FORM FOR EMC TESTING 


Fields marked with an * need to be filled out in order to submit this form


* Applicant Firm:
* Street Address: 
 
* City:
* State/Province:   * ZIP/Postal Code:
* Country:
Factory Name:
Street Address: 
 
City:
State/Province:   ZIP/Postal Code:
Country:
Product type: 
 
Model:
Rate Voltage:
Rate Input Power:
Protection Type:
Protection Class:

Configuration of Equipment:
 Rev.
 Rev.
 Rev.

Potential Sources of Interference:

Internal Frequencies Used:

Noise Suppression Components:

Measures Used for Electromagnetic Shielding:

* Please select the certification bodies to which you would like to submit this application for a quotation:
 Italian Quality Mark (IMQ)
 TÜV Product Service GmbH (TÜV PS)
 Underwriters Laboratories Inc. (UL)
 VDE Institute (VDE)