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1 For office use: ENAO Acc. No Date of application First Accreditation Renewal of Accreditation 1.THIS FORM SHOULD BE COMPLETED IN FULL AND RETURNED TO: Ethiopian National Accreditation Office Attention: Accreditation Director PO Box 3898 ADDIS ABABA Tel: Fax: The Following documents shall be submitted together with the application form. Quality Manual and supporting Procedures Authorized inspection method(s) Completed Horizontal Check list form Summary of Internal audit and clearance report. Evidence legal license Evidence about availability of adequate data after Implementation of Quality Management system (i.e. after conduct of internal Audit and NC clearance) as indicated in ENAO P07 recent version. Risk Analysis Report 2. INSPECTION BODY DETAILS 2.1 of the Inspection body Region Postal address Telephone: of Parent Organization (If part of an organization) Telephone: City Fax: Fax: Rev October 2018 Page 1 of 7

2 2.3 Legal Status and Date of Establishment (please give Registration No. and name of authority who granted the registration) 2.4 Organization Registered as Private limited company Private partnership Public limited company Government body 2.5 Type of inspection body is your organization, as defined in ISO/IEC clause 4.2 Other Type A Type B Type C 2.6 Is inspection Subcontracted? (if yes, please specify the subcontracted work) Yes No 3. ACCREDITATION DETAILS 3.1 Is your organization accredited by another accreditation body? If so please specify (attach documents for proof) No. Activity and Scope of Accreditation of Accrediting Institution Against which Standard/ Regulation Period of Validity of Accreditation Rev October 2018 Page 2 of 7

3 3.2 Scope of Accreditation Sought Please complete the following table as precisely as possible and include, wherever possible, standard methods and specification involved. This may be Ethiopian, regional and international standards. The title of the method or specification, it s number and date of issue should be listed. (use extra sheet if necessary No. Item, materials or system inspected Specific types of inspection Standards /codes or specific inspection method Rev October 2018 Page 3 of 7

4 3.3 Extension of Scope of Accreditation If you wish to extend existing scope of accreditation, you will need to fill in this form and supply the following additional information: I Accreditation Number II. Brief description of the scope of accreditation III. Date of Expiry of accreditation IV. Extension Requested for and the applicable standard/regulation Rev October 2018 Page 4 of 7

5 4. ORGANIZATION 4.1 Authorized Representative for Accreditation related matters: 4.2 Total number of staff in inspection body for the specific field applied 4.3 Please list the name and technical qualification of the following staff manager (or equivalent) of Inspection body Deputy Manager (or equivalent ) of Inspection body Quality Manager (or equivalent) of Inspection body Deputy Quality Manager (or equivalent) of Inspection body 4.4 Person authorized to sign the inspection reports (please add separate sheet where required) No Inspection field Work Experience (years) Rev October 2018 Page 5 of 7

6 4.5 Does the inspection body operate on several sites: Yes No (if yes, please fill the following address) Country Region Zone City Wereda 4.6 Organization Chart Indicate in an organization chart the operating departments of inspection body for which accreditation is being sought (please append) Indicate how the inspection body is related to external organizations or to its own parent organization (where applicable) 5. DECLARATION I enclose a copy of the quality manual and a copy of the relevant, authorized inspection method(s). Rev October 2018 Page 6 of 7

7 I declare that I am authorized, on behalf of the company/ organization, to furnish this information, and the information contained herein is both correct and accurate to the best of my knowledge and belief. Date Ful l Na me Signature: Position: Rev October 2018 Page 7 of 7