RoHS Consolidation Report Requisition Form(RoHS整合报告申请表)

RoHSConsolidationReportRequisitionFormRoHS整合报告申请表(即报告抬头)已付未付邮政编码付款公司(即发票抬头)SampleDescription样品名称(中/英文品名)Ref.No.参考号码ItemNo.型号Factory工厂名称Buyer’sName买家CountryofOrigin原产国Reportin报告语种:FORMCHECKBOXEnglish英文FORMCHECKBOXChinese中文TurnaroundTime服务周期:5-7workingdayswithcompliantapplication收到符合要求的申请表后5-7个工作天报告送递(可多选):FORMCHECKBOX传真FORMCHECKBOXEmailFORMCHECKBOX自取FORMCHECKBOX快递到付报告寄至:中文地址:*所有资料请确实填写，报告完成后如需修改报告内容，将收取报告修改费公司盖章及代表签名:AuthorizedSignatureandCompanyChopoftheApplicant日期

CONSOLIDATEDTESTDATA:整合报告测试数据:ITEMNO.PARTNO.ComponentDescriptionTESTSAMPLETESTLABREPORTNO.

ISSUEDDATETESTDATA

(ppm)编号料号零部件名称检测样品报告发出机构报告编号及发出时间检测数据

(ppm)************************************************************************************disclaimers:Thetestdataobtainedandthetestreportsissuedbylaboratoriesotherthan*******areprovidedbytheapplicantto*******fordataconsolidationpurposes.ThisisasummaryconsolidatingTHEtestdataANDTHETESTREPORTSprovidedbytheapplicantto*******andhencethisconsolidatedtestdatAreportshallinnoeventbetreatedordeemedtobeaformaltestreport.*******willnotverifyandberesponsiblefortheaccuracy,completeness,adequacyand/ORgenuinenessofalloranyofthetestdataandthetestreportssubmittedbytheapplicantto*******.innoeventshall*******oranyofitsofficersbeordeemedtobeliableforanyLOSSORDAMAGES,WHETHERdirect,incidentalorconsequentalLOSSORdamages(includingwithoutlimitationdamagesforlossofprofitsandbusinessinterruption)arisingoutofORINCONNECTIONWITHtheuse,quote,relianceorwhatsoeverofanyinformationprovidedinthisconsolidatedtestdataREPORT,oranyclaimattributabletoerrors,omissionsorotherinaccuraciesinthISconsolidatedtestdataREPORTortheinterpretationsthereof.INCASETHEREISANYCONFLICTBETWEENTHEDISCLAIMERSSTATEDHEREINANDTHEAPPLICABLETERMSANDCONDITIONSOF*******,THEDISCLAIMERSSHALLPREVAIL.声明:整合报告不等同于测试报告的效力。整合报告中所列的数据都由申请者提供，*******对所列数据未经确认，对其真实性不负责任，申请者应对所整合内容的真实性负责。申请者同意承担由整合报告所引起的所有法律责任。如果此