9.
OVEREENSTEMMINGSVERKLARING
Valbeveiligingssysteem:
___________________________________________________________________________________________
___________________________________________________________________________________________
Naam/Ontvanger/Opdrachtgever:
___________________________________________________________________________________________
___________________________________________________________________________________________
Adres:
___________________________________________________________________________________________
___________________________________________________________________________________________
Bouwplaats/Gebouw/
___________________________________________________________________________________________
___________________________________________________________________________________________
Etage:
___________________________________________________________________________________________
___________________________________________________________________________________________
Naam installateur:
___________________________________________________________________________________________
___________________________________________________________________________________________
Adres:
___________________________________________________________________________________________
Beschrijving bevestigingsinrichting:
___________________________________________________________________________________________
___________________________________________________________________________________________
Aantal toegestane gebruikers:
___________________________________________________________________________________________
___________________________________________________________________________________________
Beschrijving bevestigingssysteem:
___________________________________________________________________________________________
___________________________________________________________________________________________
Datum voltooiing:
___________________________________________________________________________________________
___________________________________________________________________________________________
Verankeringsbodem:
MAT-MA-0005-NL D-BOLT
(is volgens DIBt-richtlijn enkel in Duitsland nodig)
Beton
______________________ (vastheidsklasse)
Cellenbeton
______________________ (vastheidsklasse)
Spanbeton
______________________ (vastheidsklasse)
Staal
______________________ (vastheidsklasse)
09/06/2017
Pagina 13 van 18