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:	Adjustable Speed DPS Alarm Systems Audio/Visual Products Household Appliances Information Technology Equipment Industrial Scientific Equipment Lamps and Luminaries Medical Equipment Programmable Controllers Telecommunications Equipment UPS Equipment Vehicles with Spark Ignition Other (specify)
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)

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