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Please note:
If you want to submit more that one product for verification, please download the pdf version of this form.
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Name *
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Job Title *
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Company/Organisation *
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Mailing address *
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E-mail address (for confirmation) *
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Office telephone *
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Mobile phone
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Name and address for invoicing, if different from above:
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Number of relevant locations: *
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Approximate turnover: *
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Number of Employees: *
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Brief description of your organisations’ activities (including any relationship as part of a larger organisation) :
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*
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Current certifications and approval held by your organisation (part 1):
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Standard:
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Certification Body:
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Certificate No.:
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Current certifications and approval held by your organisation (part 2) :
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Standard:
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Certification Body:
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Certificate No.:
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Scope of management system certification(s), if held:
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Your Product
If you want to submit more that one product for verification, please download the pdf version of this form.
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Full Product Name : *
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Model Number or Reference : *
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Brief Product Description
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*
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Vehicle Impact Test Performance Classification:
Please specify the classification to which your vehicle security barrier has been tested, in accordance with paragraph 4 of BSI PAS 68:2010
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Test Vehicle Information: *
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Vehicle type: *
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Vehicle weight: *
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Vehicle speed: *
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Impact angle : *
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Vehicle Penetration Distance: *
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Dispersion of major debris:
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*
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Resistance to removal by manual attack (optional):
Please specify product security rating in accordance with LPS 1175: Issue 6
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Overseas Markets Compliance (optional):
Please specify compliance achieved with overseas standards e.g. ASTM F256-07)
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Test Report Numbers and Name of issuing organisation:
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Test organisation accreditation reference number :
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Other information that you wish PSSA to take into account during product verification :
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Application Declaration
I hereby confirm, as authorised representative of (Organisation name)
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that: *
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- The information provided on this application is correct and complete
- We have read, and subject to acceptable quotation, accept the PSSA Product Verification Scheme Agreement, including terms and conditions of business
- The PSSA, and where necessary its elected certification body, may discuss this application with those involved in testing and evaluation of the vehicle security barriers
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Name: *
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Job Title: *
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