Annex V

The EU declaration of conformity referred to in Article 28, shall contain all of the following information:

• 1. Name and type and any additional information enabling the unique identification of the product with digital elements
• 2. Name and address of the manufacturer or its authorised representative
• 3. A statement that the EU declaration of conformity is issued under the sole responsibility of the provider
• 4. Object of the declaration (identification of the product with digital elements allowing traceability, which may include a photograph, where appropriate)
• 5. A statement that the object of the declaration described above is in conformity with the relevant Union harmonisation legislation
• 6. References to any relevant harmonised standards used or any other common specification or cybersecurity certification in relation to which conformity is declared
• 7. Where applicable, the name and number of the notified body, a description of the conformity assessment procedure performed and identification of the certificate issued
• 8. Additional information:

Signed for and on behalf of:

(place and date of issue):

(name, function) (signature):