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1. The machinery or related product (product, type, model, batch or serial number) or substantially modified machinery or related product.

2. Name and address of the manufacturer and, where applicable, its authorised representative.

3. For lifting machinery which is intended to be permanently installed in a building or a structure and which cannot be assembled in the manufacturer’s premises but can only be assembled at the place of use, the address of that place.

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

5. Object of the declaration (identification of the machinery or related product allowing traceability; where necessary for the identification of the machinery or related product, a colour image of sufficient clarity may be included).

6. The object of the declaration referred to in point 5 is in conformity with the following Union harmonisation legislation.

7. References to the harmonised standards referred to in Article 20(1) or common specifications adopted by the Commission in accordance with Article 20(3) that were applied, including the date of the publication of the reference to harmonised standards in the Official Journal of the European Union or of the common specification, or references to the other technical specifications, including their date, in relation to which conformity is declared. In the event of partial application of harmonised standards or common specifications, the EU declaration of conformity shall specify the parts which were applied.

8. Where applicable, the notified body … (name, number) … performed the EU type-examination (Module B) and issued the EU type-examination certificate … (reference to that certificate), followed by conformity to type based on internal production control (module C) or the conformity based on unit verification (module G) or full quality assurance (module H).

9. Where applicable, the machinery or related product is subject to the conformity assessment procedure based on internal production control (Module A).

10. Additional information: Signed for and on behalf of: … (place and date of issue): (name, function) (signature): PART B EU declaration of incorporation of partly completed machinery No … () The declaration of incorporation shall contain the following particulars: 1. The partly completed machinery (product, type, model batch or serial number).

2. Name and address of the manufacturer and, where applicable, its authorised representative.

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

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

5. A sentence declaring which essential health and safety requirements set out in Annex III of Regulation (EU) 2023/1230 of the European Parliament and of the Council () are applied and fulfilled and that the relevant technical documentation was drawn-up in accordance with Annex IV, Part B, and, where appropriate, a sentence declaring the conformity of the partly completed machinery with other relevant Union harmonisation legislation.

6. References to the harmonised standards referred to in Article 20(1) or common specifications adopted by the Commission in accordance with Article 20(3) that were applied, including the date of the standard or of the common specification, or references to the other technical specifications, including their date, in relation to which conformity is declared. In the event of partial application of harmonised standards or common specifications, the EU declaration of incorporation shall specify the parts which were applied.

7. An undertaking to transmit, in response to a reasoned request by the national authorities, relevant information on the partly completed machinery. This shall include the method of transmission and shall be without prejudice to the intellectual property rights of the manufacturer of the partly completed machinery.

8. A statement that the partly completed machinery shall not be put into service until the final machinery into which it is to be incorporated has been declared in conformity with this Regulation.

9. Additional information: Signed for and on behalf of: … (place and date of issue): (name, function) (signature):