KSB

Edit B5 - Questionnaire for Suppliers of Accessories

1. Are you Manufacturer or Dealer

Dealer (If dealer, please attach dealership certificate with product details.)

Manufacture

2. Products in scope of supply

3. Product Certification

Weather Proof

Flame Proof

CCOE

ATEX

Other (Specify)

Flame Proof Certificate

Intrinsically safe

CCOE

ATEX

Other (Specify)

Intrinsically safe Certificate

4. a. If manufacturer, Details of manufacturing facility

Equipments	Qty	Make	Installed Since	Action

Do you supply products for corrosive atmosphere ( Free from Cu or Copper Alloys)

Yes
if yes, provide details

Sales quantity of products in last year

Product

Quantity

4. b. Details of test facilities for Incoming Material

Equipments	Qty	Make	Installed Since	Action

4. c. Details of test facilities for Product

Equipments	Qty	Make	Installed Since	Action

5. Do you employ any ND Testing

Yes
if yes, provide details

List of qualified personnel. (Attach the Certificates)

Qualified Personnel

Certificate

Is the NDT Procedure approved by Level III Person. (Attach Copy)

6. How the traceability of components ensured?

7. Do you provide product Certificates

Yes

if yes, Attach Sample Copy

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Edit B5 - Questionnaire for Suppliers of Accessories