EU DECLARATION OF CONFORMITY

1. PPE:

Custom Moulded Earplugs

2. Name and address of the manufacturer:

AT SOURCE QX LTD T/A PROTECTHEAR®

18 EVE STREET, LOUTH, LINCOLNSHIRE, LN11 0JJ

3. This declaration of conformity is issued under the sole responsibility of the manufacturer:

AT Source QX

4. Object of the declaration (identification of PPE allowing traceability; where necessary for the identification of the PPE, a colour image of sufficient clarity may be included):

Custom Moulded Earplugs, Solid and Vented.

Models PHV – ProtectHear Vented (90-OP) and PHS – ProtectHear Solid (91-OP)

5. The object of the declaration described in point 4 is in conformity with the relevant Union harmonisation legislation:

PPE Regulation 2016 / 425.

6. References to the relevant harmonised standards used:

EN 352 part 2: 2002

7. The notified body SATRA 2777 performed the EU type-examination (Module B) and issued the EU type-examination certificate XXXXXXXXX.

8. The PPE is subject to the conformity assessment procedure conformity to type based on internal production control plus supervised product checks at random intervals (Module C2) under surveillance of the notified body SATRA 2777.

Signed for and on behalf of AT SOURCE QX

(Place and date of issue)

(Name, function)

(Signature):

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