Annex IV

The EU declaration of conformity shall contain the following information:

1. 1.

   Name, registered trade name or registered trade mark and, if already issued, SRN referred to in Article 28 of the manufacturer, and, if applicable, its authorised representative, and the address of their registered place of business where they can be contacted and their location be established;

2. 2.

   A statement that the EU declaration of conformity is issued under the sole responsibility of the manufacturer;

3. 3.

   The Basic UDI-DI as referred to in Part C of Annex VI;

4. 4.

   Product and trade name, product code, catalogue number or other unambiguous reference allowing identification and traceability of the device covered by the EU declaration of conformity, such as a photograph, where appropriate, as well as its intended purpose. Except for the product or trade name, the information allowing identification and traceability may be provided by the Basic UDI-DI referred to in point 3;

5. 5.

   Risk class of the device in accordance with the rules set out in Annex VIII;

6. 6.

   A statement that the device that is covered by the present declaration is in conformity with this Regulation and, if applicable, with any other relevant Union legislation that provides for the issuing of an EU declaration of conformity;

7. 7.

   References to any CS used and in relation to which conformity is declared;

8. 8.

   Where applicable, the name and identification number of the notified body, a description of the conformity assessment procedure performed and identification of the certificate or certificates issued;

9. 9.

   Where applicable, additional information;

10. 10.

    Place and date of issue of the declaration, name and function of the person who signed it as well as an indication for, and on behalf of whom, that person signed, signature.