EC-Declaration of Incorporation of

Partly Completed Machinery

In accordance with the EC machine directive 2006/42/EG of 17. May 2006, appendix II B
We hereby declare that the following described partly completed machine in its conception,
construction and form put by us on the market, is in conformity with all the relevant essential
health and safety requirements of the EC machinery directive 2006/42/EEC as amended
and the national laws and regulations adopting this directive. In case of alteration of the
Partly Completed machine, not agreed upon by us, this declaration will lose its validity.

name and address of the manufacturer or of authorised representative in EU: 1)

Muster GmbH,
Musterstraße 65
D-27635 Musterstadt
Tel.: +49(0)48763/57647-0

Description of the machine:

• function:
• type/model:
• serial number:
• year of construction:

Furthermore we explain the agreement with further, likewise for the product valid
directives/regulations:
• EG- Druckgeräte-Richtlinie (97/23/EG) vom 27. Mai 1997
• EMV-Richtlinie (2004/108/EG) vom 15. Dezember 2004

Applicable Harmonized Standards:

• DIN EN 12100-1 Sicherheit von Maschinen - Grundbegriffe, allgemeine
Gestaltungsleitsätze, Teil 1: Grundsätzliche Terminologie, Methodik
• DIN EN 12100-2 Sicherheit von Maschinen - Grundbegriffe, allgemeine
Gestaltungsleitsätze, Teil 2: Technische Leitsätze und Spezifikationen
• DIN EN 60204-1 Sicherheit von Maschinen - Elektrische Ausrüstungen von Maschinen,
Teil 1: Allgemeine Anforderungen
• DIN EN ISO 13849 Sicherheit von Maschinen- Sicherheitsbezogene Teile von
Steuerungen

Other technical standards and specifications used: 2)

We explain further that special technical information for this incomplete machine were
provided after appendix VII, part B and to obligate us, these on demands over ours< convey
construction line>3) the market supervisory authorities.

The person authorised to compile the relevant technical documentation:

4)
(surname, first name, address)

Place/date:

Personal data of the signer:

(surname, first name, position)

Signature:

(A) This explanation is to be drawn up in the same language as the original operating instructions; machine in
writing or in type characters. A translation into the national language must be attached. 1) complete address of
the manufacturer; with authorized person likewise complete address of the manufacturer 2) if still no
appropriate harmonized standards established in the European Union are present. 3) is to be regarded only as
example 4) must reside in the community