Form for the application to issue a

European Technical Assessment (ETA)

under article 26 of regulation (EU) 305/2011 or

under article 37 of regulation (EU) 2024/3110

The application is made to the Technical Assessment Body (TAB);
LUXIB – Luxembourg Institute for Building and Technology S.A.
62, Avenue de la Liberté
1930 Luxembourg

Applicant/manufacturer (Name and address)

Type of construction product

Trade name(s) of the product, which shall be included in the ETA

Description of the construction product

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Assessment of essential characteristics of the product (please mark with cross)

☐	Case 1:	The construction product is covered by the following European Assessment Document (EAD)
Reference number of the EAD:	Klicken oder tippen Sie hier, um Text einzugeben.

☐	Case 2:	The construction product is covered by the following European technical approval Guideline (ETAG)
Reference number of the ETAG:	Klicken oder tippen Sie hier, um Text einzugeben.

☐	Case 3:	The construction product is partially covered by an existing harmonised standard (hEN) or a European Assessment Document (EAD)
Reference number (hEN / EAD):	Klicken oder tippen Sie hier, um Text einzugeben.

☐	Case 4:	For the construction product there are no applicable harmonised methods and criteria for assessing the performances of the product under a hEN, an EAD or an ETAG

☐	Case 5:	The construction product is already covered by an ETA, that needs to be adapted, completed or issued in the applicant’s own name.
Reference number of the ETA:	Klicken oder tippen Sie hier, um Text einzugeben.

Required documents

A complete technical documentation of the products (please mark with cross)

☐ is attached to the application form

☐ will be send latest until Klicken oder tippen Sie hier, um Text einzugeben.

Manufacturing plant(s)

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Declaration of the applicant

Hereby declare that (please mark with cross)

☐	I have not filed an application for a European Technical Assessment for the construction product with any other Technical Assessment Body (TAB)

☐	I have filed an application with:
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That request was rejected / not processed / withdrawn, for the following reasons:
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Furthermore, I declare that I

I will bear the costs of issuing the European Technical Assessment according to the contract with LUXIB,

will provide the necessary support in the process of issuing the European Technical Assessment,

will ensure that the manufacturing plant(s) can be visited at any time during the operating times by representatives of LUXIB and

agree that the European Organisation for Technical Assessment (EOTA) and the European Commission (EC) shall be informed about the content of this application.

I further declare that I am prepared to inform LUXIB without delay of the first making available of the product on the market with CE marking.

…………………………………………. Place and date	…………………………………………. Signature