application for
Certification / Modification

type of certification application

(* tick as appropriate)

Existing Certificate No.

applicant / certificate holder Details

Business Name
Address 1
Address 2
Address 3
City
Country
Post Code
ABN
( if an Australian company)
Contact Name
Phone
Email

Note: Product Compliance Certification will not be approved unless a declaration of compliance is signed (last page of this document) by the above applicant.

consultant details

Complete where the application is lodged by an Agent on behalf of the Applicant. Note: Please provide a letter from the applicant authorising you/your Company to act as a Consultant on their behalf.

Business Name
Address 1
Address 2
Address 3
City
Country
Post Code
ABN
Contact Name
Phone
Email

product details

(* tick as appropriate)

Regulatory Description *
General Description
Trade Name / Brand
Main Model Number
Additional Models (if applicable)
Enter each model in a new line
Regular Product Function
Ratings Voltage/ Freq Current(Amps) Power(W) IP(ingress protection)
Input Ratings
Output Ratings
Other relevant ratings Insulation Class Attachment
Input Ratings

Difference between models

(Where more than one model is applied) Provide a separate page if insufficient space

modification details

Difference between approved model and modified model(s)

Specify all changes to the design, material, construction, software or place of manufacture from the previously approved electrical equipment - if insufficient space attach further details

applicable standards

Please list prescribed or relevant safety standards for certification.

supplied test report details

Report Number Report Date Laboratory Accreditation

safety-critical components reference

Please provide page number references for a list of any safety-specific components included in the product.

Report Number Report Page Number

manufacturer details (THESE DETAILS WILL NOT APPEAR ON THE ASA CERTIFICATE)

Manufacturer Name
Manufacturer Address
Factory Name
Factory Address

Withdrawal and Suspension of Certificates

A Certificate may be suspended on the following grounds:

  • Any grounds prescribed by the NSW Electricity (Consumer Safety) Regulation 2006
  • By written request of the certificate holder to Australian Safety Approvals (ASA),
  • By written request of the regulatory authority to ASA
  • The electrical article design is found to be unsafe by ASA
  • The electrical article is found NOT to comply with the relevant or prescribed safety standards for the model or requirements of the Regulation

When the Certificate of Approval is suspended for any reason ...

  • Australian Safety Approval (ASA) will advise the relevant regulatory authorities and the approval holder, in writing, within 5 days of certificate suspension.
  • The approval holder will discontinue the sale of the article subject to the certificate suspension, as well as the use of all advertising matter that contains any reference to the article.
  • The approval holder will reply to Australian Safety Approval (ASA) to confirm such undertaking.
  • The approval holder will be referred to the relevant regulatory authority for subsequent resolution regarding such approval suspension.

A Certificate remains suspended for no more than 90 days, after which the matter is resolved or the certificate is subsequently withdrawn indefinitely.

consultant authorisation letter

Where a Consultant (Agent) has been engaged on behalf of the application, a Consultant Authorisation Letter must be supplied by the applicant and include the following:

  • Product Identification
  • Applicant's Declaration that ...
    • The product(s) described in the application comply with the nominated standards.
    • The products identified in the test report(s) are identical to the product(s) described in the application.
    • Any modifications (components, construction, materials, software) to the product(s) described in the application will be identified by further application to the regulator for modification to the Certificate.
  • Applicant's agreement to the Terms and Conditions2 for holding the Certification for the product(s) described.
    _________________________________________
  • NSW Electricity (Consumer Safety) Regulation 2006
  • Refer to ASA Product Approval Guide (ASA GL)

payment details

Invoice for payment will be emailed upon receipt of application. Please note applications will not be assessed until full payment is received.

documentation checkList

Documents Supplied Documents Supplied
Test Report*
Circuit Diagrams
Clear Color Photos*
Safety-Critical Component List*
Rating Label Photo or Artwork*
Alternative Components List
User Instructions or Installation
Instructions*
Other (please specify)
Consultant Authorisation Letter
(if applicable)

* THESE DOCUMENTS ARE MANDATORY AND MUST BE SUPPLIED WITH YOUR APPLICATION
THESE DOCUMENTS ARE MANDATORY AND SHOULD BE FOUND IN YOUR TEST REPORT(S),
IF THEY ARE NOT PLEASE PROVIDE THEM SEPARATELY

applicant's declaration

I Hereby Declare:

  • That the product(s) described in this application:
    • Comply with the requirements of the NSW Electricity (Consumer Safety) Act 2004 and the Electricity (Consumer Safety) Regulation 2006.
    • Comply with the requirements of the nominated standards.
  • That the product(s) identified in the test report(s) are identical to the product(s) described in this application.
  • That any modifications (components, construction, materials, software) to the product(s) described in this application will be identified by further application to ASA for modification to the Certificate.
  • That I agree to the Terms and Conditions of the ASA Certification Scheme as documented in the Scheme Guidelines (ASAgl), in relation to holding Certification for the product(s) described and that such terms and conditions will be applied.
  • That I allow ASA to upload the certificate, once approved, to the EESS Database: