TEMPLATE FOR DECLARATION OF CONFORMITY
We,(name of Product Owner or Physical Manufacturer), as the (Product Owner or Physical Manufacturer) hereby declare that the below mentioned devices have been classified according to the classification rules and conform to the Essential Principles for Safety and Performance as laid out in the ASEAN Agreement on Medical Device Directive.
Name and Address of Product Owner:
(Person who is responsible for medical device according to the definition of ASEAN Agreement on Medical Device Directive)
Authorized Representative :
(Local authorized representative responsible for placing the medical device on the market of Thailand)
Medical Device(s):
(e.g. product name and model number)
Risk classification: e.g. Class B, rule
(Class of Device according to the classification rule, and the rule used to determine the classification)
Quality Management System Certificate:
(Certification Body and Certificate Number, issue date, expiry date)
Standards Applled:
(International standards, OR Regional Standard, Or See Attached Schedule for muitiple Standards)
This declaration of conformity is valid from (Day Month year)