Commitment letter of quality assurance 1 construction unit:
Supervision unit:
Building area (㎡):
Design unit:
Construction unit:
Service life:
The employer and the contractor shall sign the project quality guarantee through consultation according to the Construction Law of People's Republic of China (PRC), Regulations on Quality Management of Construction Projects and Measures for Quality Assurance of Housing Construction Projects.
Article 1 Within the quality warranty period, the contractor shall undertake the quality warranty responsibility of the project in accordance with the management provisions of relevant laws, regulations and rules and the agreement of both parties. The scope of quality warranty includes basic engineering, main structure engineering, roofing waterproof engineering, leakage prevention of toilets, rooms and external walls with waterproof requirements, electrical pipelines, water supply and drainage pipelines and other projects agreed by both parties.
Article 2 Specific Contents of Quality Assurance Clauses According to the Regulations on Quality Management of Construction Projects and relevant regulations, both parties agree that the quality assurance of this project is as follows:
1. Ensure that the basic engineering and the main structure engineering reach a reasonable service life;
2. Ensure that the roof is waterproof and the bathroom has anti-leakage performance;
3. Ensure that the whole floor is wind-resistant, waterproof and earthquake-resistant;
4. Ensure the smooth flow of water and electricity in the building;
5. Ensure that the building height of each floor of the house meets the requirements of the owner;
6. Ensure that the building structure meets the requirements of Party A; Quality assurance shall take effect from the date of project completion acceptance.
Article 3 Quality Warranty Responsibility
1. If the above requirements are not met, the contractor shall send someone to be responsible for maintenance or reconstruction within 7 days from the date of receiving the notice from Party A. If the contractor fails to send someone to build it within the agreed time limit, the employer may entrust others to repair it. The expenses shall be borne by the contractor.
2. In case of emergency repair accident, the contractor shall immediately arrive at the scene of the accident for emergency repair after receiving the accident notice.
3 for structural safety and quality problems, it shall immediately report to the local construction administrative department in accordance with the provisions of the "Measures for Quality Assurance of Housing Construction Projects" and take safety precautions; The local safety building management department or the design unit with corresponding qualification grade puts forward the warranty scheme, and the contractor implements the warranty.
4. Party B shall be fully responsible for the collapse, cracks, inclination and other factors of the house caused by force majeure. (Force Majeure: refers to the explosion, fire and catastrophic natural disasters caused by war, turmoil, falling objects in the air or other reasons not attributable to Party A and Party B ...)
Article 4 The warranty expenses and construction expenses arising from building quality problems shall be borne by Party B. ..
Construction unit (seal):
Construction enterprise (seal): legal representative:
Legal representative: YY.
Letter of Commitment on Quality Assurance (2) If our company succeeds in the model project, we will strictly abide by all the commitments made in this tender and contract, strictly perform all the obligations and responsibilities of the contract, and carefully maintain and complete the maintenance and management tasks with good quality and quantity in combination with the actual situation. Here, our company is willing to make the following commitments:
1, comply with relevant laws and regulations.
2. Ensure that the green space maintenance management reaches the first-class maintenance management quality standard of Tianjin landscaping.
3. Maintenance management units need to do a good job of replanting seedlings, clean up dead seedlings and residual seedlings in time, replant them according to standards and requirements, and carry out maintenance management in time.
4. When the green seedlings are damaged, Party B must provide a damage report, and both parties shall determine the responsibilities, and Party B shall only bear the damage repair expenses within its responsibility scope; If Party B fails to submit the damage report in time, Party B shall pay all the repair expenses.
5. According to the contract price (within 20 days after the contract is signed, the mechanical equipment needs to be verified by the owner, and if we fail to provide it on time, the owner has the right to terminate the contract, and the responsibility shall be borne by us), the contract period, quality and safety, contract labor, materials and mechanical equipment.
6. The owner gives us corresponding funds for greening management and maintenance tasks. We organize management and maintenance work according to the owner's management requirements and standards, and accept the owner's guidance, supervision, inspection and acceptance.
7, according to the provisions of the state should be paid by our various expenses, has been included in the contract price, delivered by our direction to the relevant departments.
8. The owner checks our personnel every month. If the personnel still fail to meet the requirements after rectification, we can deduct points. If the quantity is less than 90% of the required quantity, 5% of the monthly maintenance fee will be deducted; if it is less than 80%, 10% will be deducted, and so on.
9, establish and improve the construction quality inspection system, strict process management, completes the concealed engineering quality inspection and record.
10, establish a quality responsibility system, and be responsible for the construction quality of greening projects. This project is a greening maintenance project, and our company is a first-class qualification enterprise for urban landscaping, and is fully capable of undertaking this project. If our company wins the bid, we won't subcontract.
1 1, and inspect and quarantine the seedlings and other materials according to the maintenance technical standards and contracts.
12. Establish and improve the project organization and clarify the responsibilities of personnel. The project manager is responsible for the establishment and operation of the project quality assurance system; Coordinate the project quality plan and related work arrangements, carry out quality education, and ensure that
All kinds of systems in the company are running normally.
13, consciously accept the supervision and management of the owner, the masses and relevant departments during the maintenance period.
(1) We unconditionally obey some surprise missions and inspection activities organized by the owner, and complete the assigned work on time, according to standards and requirements. If the inspection-welcoming project is unqualified due to inadequate maintenance during the inspection-welcoming activities, the maintenance fund for one month will be deducted. If the inspection-welcoming project is unqualified due to inadequate maintenance for the second time in a row, the owner has the right to unilaterally terminate the maintenance contract and impose a fine of 5% of the bid price on us.
(2) We must respond positively and accept the supervision and inspection of the municipal leaders. Criticized by the city leaders, the investigation is true, depending on the seriousness of the month's green maintenance assessment for a fine; In case of adverse effects, the owner has the right to terminate the contract unilaterally.
(3) We must accept public supervision anytime and anywhere. If the public complaints are verified through investigation, they will be fined according to the seriousness of the case; In case of adverse effects, the owner has the right to terminate the contract unilaterally.
14. During the implementation, we will perform various duties according to the terms of the contract. If it is found that our organization measures are improper, the plan is not implemented, the management is lax, and the personnel and machinery listed in the greening maintenance implementation plan are not in conformity with the actual situation on site, resulting in the substandard greening maintenance quality, and the rating of the month is poor, and at the same time, we will impose penalty for breach of contract according to the poor standard agreed in this contract; In serious cases, the owner has the right to terminate the contract unilaterally.
15. According to the management and maintenance contents undertaken in this contract and the actual number of employees, go through the formalities of employment, labor protection and temporary residence permit in the relevant departments. Arrange accommodation and education management for subordinates.
16. Safety production and fire prevention measures must be implemented. We will buy uniform work clothes or reflective sleeves for the workers on duty according to the requirements of the owner, and solve the problem of safe operation of the expressway by ourselves. When carrying out maintenance work, be serious and responsible, and pay attention to safe operation. In case of any accident, we are responsible for handling the accident and bearing all the expenses.
17, we must strictly abide by the provisions of national laws and regulations and do a good job in comprehensive management of social security. Shall not violate the provisions of national laws and regulations. If our employees violate the law and discipline, we will bear all economic and legal responsibilities.
18. During the contract period, if Party B needs to adjust the green area under the care of Party B due to national construction requisition or owner management, we will obey the overall situation and take the initiative to coordinate with the owner to handle the relevant procedures, and reduce the contracted area and funds accordingly.
The owner is not responsible for the economic losses caused by this.
19. If we stop work without reason, the owner has the right to deduct the loss.
Maintenance, and have the right to ask us to pay a penalty equivalent to 5% of the total contract price. If the work stoppage reaches 7 days without reason, the owner has the right to terminate the contract unilaterally.
20, we cooperate with the owner to do a good job of publicity and supervision of landscaping, educate the public to abide by the relevant provisions of landscaping management and cooperate with the sanitation and cleaning work.
2 1, in line with the water supply planning and technical conditions, the owner can assist us to handle the special water supply port for greening and maintenance according to actual needs, but the labor and material costs are paid by us. The water fee (including sewage treatment fee) required during the maintenance period shall be borne by us and paid directly to the water supply department by us.
22. Choose excellent maintenance teams, sign labor contracts with them according to law, pay workers' wages on time, and never default on migrant workers' wages.
23, a weekly project meeting, presided over by the supervision, the owner and the project intends to attend. Through the regular meeting of the project, improve the relationship between construction, supervision and owners, coordinate various problems in the construction process, and ensure the smooth progress of the project.
24. When the project meeting is held, the project manager department will submit a weekly work report and a work plan for next week to the owner. In the report, the progress of the project will be described in detail, and the detailed plan of progress, materials, labor, equipment and funds will be detailed in the plan.
Commitment letter of quality assurance 3 Our company strictly abides by the ISO900 1 quality assurance system, and the products are designed, manufactured and tested in full accordance with the standards, and always adhere to the purpose of "quality first and service first".
From contract review, raw material procurement to product ex-factory inspection, there are layers of checks and records. Records of all quality control links in product production are traceable, and unqualified parts will never flow into the next process, so that each ex-factory product is 100% qualified. In the future cooperation process, high-quality, warm and thoughtful pre-sale, mid-sale and after-sale services will definitely make you feel value for money. Our company solemnly promises that the products provided are all qualified products.
Organizational guarantee measures
In view of this project, the company specially deploys the backbone personnel of the company to form a project team, and the general manager of the sales department is responsible for all production progress and business matters during the implementation of this project; The technical quality department is responsible for production technology, quality and product development. Design progress control of contract delivery guarantee measures: CAD technology and computer selection software are used in the design, which can quickly complete the drawing design.
Contract quality assurance measures
Over the years, the company has been adhering to the quality policy of "careful design, strict production, dedicated service, ensuring quality and optimizing space", and regards product quality as the life of the company, forming a unique quality control system, including production process control, product entity quality control and after-sales service quality control. Production process control: according to ISO900 1 standard, a scientific quality assurance system is established to ensure the working quality of product production process.
Physical quality of products: In the specific design stage, the "three-level audit system" is adopted for design drawings, and customers are invited to make final confirmation before production to ensure that unqualified design drawings are not put into production; In every working procedure of the manufacturing process, strict quality inspection system is implemented, and full-time quality inspectors carry out quality inspection to ensure that unqualified products do not flow into the factory.
Process; Before the products leave the factory, full-time inspectors conduct strict factory inspection to ensure that the qualified rate of the products is 100%.
Quality of after-sales service: the company has a special after-sales service department, equipped with engineers and senior technicians, and equipped with special vehicles and tools. The processed parts shall be guaranteed for one year after leaving the factory. If you need after-sales service, you can provide quality service within 3 hours in Tianjin.
Letter of Commitment for Quality Assurance 4 1, Quality Assurance System
1.65438+
1.2 quality assurance of engineering materials
Ensuring the quality and quantity of materials is the premise of improving quality. The Supply Management Department shall establish a pre-entry inspection, acceptance and inspection system for purchased raw materials, semi-finished products or finished products to prevent unqualified raw materials from entering the site.
1.3 standard quality management system
(1) Under the leadership of the management department and the chief engineer, the quality inspection department is composed of full-time engineers and is responsible for quality management.
(2) Each production team shall have full-time quality inspectors.
(3) The Quality Inspection Department shall organize an inspection every three days, and the analysis shall be made by the chief engineer.
(4) The team adheres to the "three inspection system", and the self-inspection is qualified, and the full-time quality inspector accepts it. The quality inspection engineer invites the chief engineer to accept the appraisal.
(5) Implement the technical innovation disclosure system and conduct technical exchange before production.
(6) Implement a comprehensive quality risk of mortgage system, with bonuses and wages linked to product quality and technology.
(7) The workshop director monitors the production site all the time. As long as there is a production site, there is a workshop director.
(8) implement the system of listing for posts, which is convenient for post inspection and instruction.
(9) to control the key production quality, with the consent of the chief engineer, the quality leading group will
Approved.
1.4 Correctly handle the relationship between progress and quality. Without quality, there is no progress. Organize and guide the work in strict accordance with the standards, specifications and design requirements, and never neglect the quality because of grabbing the output.
1.5 Our company solemnly promises that the quality is qualified. If the quality is unqualified, we are willing to bear the economic penalty of 1% of the total bid price.
2 Warranty commitment
2. 1 Before leaving the factory, the products should collect all kinds of experimental and quality inspection data in time, conduct analysis and research, have a clear understanding of the quality of each process, and be prepared for possible quality hazards at any time.
2.2 During the defect liability period, the completed project shall be inspected regularly, external factors affecting quality shall be eliminated in time, and existing defects shall be repaired in time.
2.3 Check the maintenance and repair records during the defect liability period in time, report and analyze the causes of defects to users in time, and propose a maintenance plan for users' approval.
2.4 Maintenance and repair scheme must be approved by users before construction.
2.5 Our company solemnly promises that if there are any quality problems during the warranty period, our company will be present unconditionally for maintenance within one week after receiving the notice. If the maintenance is not timely, our company is willing to bear an economic fine of 20xx.00 yuan each time.
1. Before the product leaves the factory, collect all aspects of experimental and quality inspection data in time, conduct analysis and research, have a clear understanding of the quality of each working procedure, and prepare for possible quality hazards at any time.
2. During the defect liability period, the completed project will be inspected regularly, and the project quality will not be affected.
Eliminate the factors in time and repair the defects that have appeared in time.
3. Check the maintenance records during the defect liability period in time, report to the user in time and analyze the causes of defects, and put forward the maintenance plan for the user's approval.
4. Maintenance and repair scheme must be approved by users before construction.
Our company solemnly promises that if there are any quality problems during the warranty period, our company will be unconditionally present for maintenance within one week after receiving the notice. If the maintenance is not timely, our company is willing to bear an economic fine of 20xx.00 yuan each time.
Shizuishan Fengben (Group) Development Co., Ltd.
20xx1Feb. 9 19
Quality Assurance Commitment No.5:
Party A (individual): (hereinafter referred to as Party A)
Party B (Company): (hereinafter referred to as Party B)
1, use
Ensure the effective operation of Party A's quality and system; In order to ensure the stability of Party B's supply quality, meet the final product demand of Party A's users and prevent the occurrence of unqualified products, this agreement is specially signed.
2. Scope of adaptation
This agreement is applicable to Party B who provides Party A's products.
3. Contents involved in the lamps quality assurance commitment letter of both parties.
3. 1 The order of lamps quality assurance commitment letter issued by Party A to Party B shall be accurately marked with: product name, model specification, delivery period, delivery method and quality guarantee period.
3.2 If Party A needs to change the contents of the lamps quality assurance commitments (orders) issued but not yet implemented, it must notify Party B in writing, and Party B shall promptly confirm and correct the contents of the lamps quality assurance commitments (orders) to Party A's representatives.
3.3 The commitment letter of lamps quality issued by Party A to Party B shall be accompanied by the quality and technical indicators and requirements of the processed and purchased products. If Party A can't clearly put forward the quality and technical indicators, it can adopt national standards or be put forward by Party B on its behalf, and a written record will be formed after both parties agree.
4. Description of quality standards
4. 1 Party A shall explain the product quality standards to Party B through drawings, standards or designated samples.
4.2 If there is any objection to the quality standard proposed by Party A, or Party B requests to change it, Party B shall apply to Party A for negotiation.
4.3 Qualified rate of products provided by Party B to Party A:
The product quality is not less than%, and the quality guarantee period is years.
The product quality is not less than%, and the quality guarantee period is years.
The product quality is not less than%, and the quality guarantee period is years.
The product quality is not less than%, and the quality guarantee period is years.
5. Quality inspection and confirmation
5. 1 Party B shall issue the factory inspection report of each batch of Party B's products according to the quality standards agreed by both parties. If necessary, Party B shall submit quality certification materials such as inspection benchmark and QC engineering list of Party B's products to Party A for confirmation.
5.2 Quality inspection is carried out at the initial stage of supply, and it is also carried out at ordinary times.
5.3 If Party A or Party B cannot complete the agreed project or national compulsory inspection, it must be carried out in the national inspection institution designated by the quality management department of Party A, and the inspection expenses shall be borne by Party B. ..
5.4 When Party A deems it necessary, Party A may inspect accessories or supervise Party B's quality assurance system at any time.
5.5 When Party B changes its production site or key processes and equipment, it must notify Party A and get Party A's approval.
6. Party B's liability for compensation
When the matching problem meets one of the following requirements, Party B shall bear the compensation liability agreed in the following 7. 1 A: The unused products of Party B do not meet the quality and technical requirements of Party A at all;
B: Party B's unilateral failure to deliver the goods on time affects the delivery time of Party A's products;
C: Problems arising from poor storage or maintenance of accessories or during transportation after inspection at the place where Party B supplies them (this clause applies to products stored and transported by Party B);
D: Sporadic unqualified products of products supplied by Party B inspected by Party A;
E: Party B's products have been accepted, and Party A found that more than 3% of Party B's products did not meet Party A's quality requirements during the production process; F: After-sales maintenance, return and transportation expenses of Party A's products caused by Party B's disqualification;
G: Other problems caused by Party A's failure to judge that Party B's ex-factory quality is qualified, but the actual quality does not meet the requirements; H: 1 percentage point when the qualified rate of batch products provided by Party B to Party A is less than 4.3 items;
J: When the qualified rate of' batch products' provided by Party B to Party A is less than 4.3 items and 2 percentage points;
K: Due to the needs of Party A's customers, after consultation with Party B, the batch pass rate is lower than the above J percentage points. ..
7. Requirements
7. 1 When Party B's products conform to the sub-items in Article 6 of this Agreement, Party B shall compensate according to the following liabilities corresponding to the sub-items in Article 6:
A: The problem is caused by product defects other than the accessories provided by Party A;
B: Problems caused by Party A changing the structure or style of accessories without consulting Party B;
C: After the products of Party A are delivered to the end users, the owners or users of the products use, keep or change the structure without authorization, resulting in problems;
D: Problems caused by defects in the technical drawings provided by Party A to Party B;
E: Problems caused by improper use and maintenance of Party A;
F: Problems caused by Party A's improper storage or maintenance.
8. Others
8. 1 This agreement is valid for one year.
8.2 This Agreement is made in duplicate, with each party holding one copy. Matters not covered herein shall be discussed separately by both parties.
(Party A) (Party B)
Signature/date of representative (seal): signature/date of representative (seal)
6 XXXXXXXX Co., Ltd. undertakes the quality of products manufactured and is responsible for the quality of products within the quality guarantee period. We hereby make the following commitments regarding the tower quality required for all tower projects undertaken:
1. Our company guarantees that all raw materials and accessories used in the tower meet the requirements of the bidding documents, technical specifications and national standards, and all of them use brand-new qualified products.
2. Our company guarantees to use advanced technology and equipment to manufacture the iron tower, and all the technical indexes of the iron tower components, such as overall dimensions, cross-sectional dimensions, welding quality, deflection of pole segments, galvanized quality, etc., meet the specification requirements, so as to ensure the smooth installation.
3. Our company takes effective control measures for special processes and key processes (welding and anti-corrosion) to ensure its internal quality stability and perfect quality characteristics. The company adopts advanced quality inspection equipment and strict inspection methods to monitor the quality indicators of products. Among them, 100% ultrasonic flaw detection is adopted for the weld.
The quality guarantee period of our products is twelve months.
5. During the warranty period, our company will give a reply within 1 hour after receiving your written notice, and be responsible for repairing or replacing the defective tower materials free of charge within 2 days to meet the requirements specified in the technical conditions.
Our company guarantees that the products provided are brand-new.
Company name: xxxxx Co., Ltd.
Date: 20xx-02-03
The quality assurance commitment is 7 1, the service slogan is to provide users with comprehensive and high-quality services, serve users wholeheartedly and faithfully, and conscientiously implement the regulations of the superior on motor vehicle maintenance management, with high quality and low price.
2. Carefully check the vehicles maintained by users and make project records, listen to the questions raised by users, fill in the maintenance items, make a valuation sheet, and the users sign for approval.
3, in the process of maintenance, found it necessary to increase the maintenance items, timely contact with users, explain the situation, get the user's reply before construction, give warm and patient explanation to users.
4, to maintain the vehicle, to ensure the quality, delivery on time, urgent user needs, the implementation of 24-hour service, for users to solve problems, equipped with rescue personnel.
5. Provide follow-up service for vehicles leaving the factory for maintenance, and guarantee them according to the quality guarantee period and engineering quality guarantee period stipulated by the state.
6. For vehicles that need to buy spare parts for maintenance, ensure that they can take the initiative to give detailed answers to the owners on issues such as price, origin and quality of the spare parts factory, and then seek the opinions of the owners for processing.
Safety commitment letter of installation, renovation and maintenance unit
Electromechanical category:
Who is engaged in the elevator, lifting machinery, passenger ropeway and large amusement facilities and other electromechanical special equipment (hereinafter referred to as electromechanical special equipment) installation, renovation, maintenance and daily maintenance of the elevator units, must obtain the "special equipment installation, renovation, maintenance license", and engage in the corresponding work within the scope of the license. The elevator daily maintenance unit must obtain the elevator maintenance qualification license.
(a) the installation, renovation and maintenance of elevators must be carried out by the elevator manufacturing unit or its construction unit authorized and agreed by the contract and approved by these rules.
(two) the elevator installation, maintenance and daily maintenance units shall sign relevant contracts or agreements with the corresponding special equipment manufacturing units to ensure their necessary technical guidance, cooperation and spare parts supply. If the manufacturing unit no longer has the qualification of manufacturing license for the corresponding type of special equipment, the unit undertaking the corresponding construction shall be responsible for ensuring that the equipment meets the requirements of the corresponding safety technical specifications and standards.
(three) the elevator daily maintenance unit must ensure that its employees can arrive at the location of the elevator in time and arrive at the scene of the accident within 30 minutes after the accident.
(4) In the process of installation and renovation, there shall be no less than 2 operators with special equipment operators' certificates on site, among whom the project leader shall be no less than 1 person and the on-site safety inspector shall be no less than 1 person.
(5) During the routine maintenance of maintenance and elevators, there shall be no less than 1 person with the corresponding operation item "Special Equipment Operator Certificate" on site.
(6) Take effective measures to eliminate potential safety hazards in construction, and conduct on-site operations in strict accordance with the construction plan prepared by the unit. When it is really necessary to adjust the construction plan, the management system of preparation, review and approval of the construction plan must be strictly implemented.
(seven) without the authorization or consent of the manufacturer, the transformation unit must replace the product nameplate of special equipment, and indicate its name, transformation date and license number on the product nameplate and quality certificate.
(eight) after the installation, renovation and major maintenance of special equipment, the construction unit must carry out strict self-inspection in accordance with the requirements of relevant safety technical specifications and standards.
Boiler:
All units engaged in boiler and pipeline installation and renovation within the scope of the Regulations must obtain the License for Installation, Renovation and Maintenance of Special Equipment issued by the General Administration of Quality Supervision, Inspection and Quarantine before they can engage in boiler installation and renovation within the scope of the license. A boiler manufacturing enterprise that has obtained a boiler manufacturing license may transform the boiler manufactured by the enterprise and install the whole (group) boiler manufactured by the enterprise without obtaining a license.
Installation and renovation units shall comply with the following provisions:
(a) shall not exceed the permitted scope of installation and renovation of boilers;
(two) shall not install and transform boiler products manufactured by units that have not obtained the corresponding boiler manufacturing license;
(three) shall not install boiler products with incomplete factory information or without supervision and inspection (except for bulk boilers that leave the factory by stages);
(four) the boiler shall not be transformed without registration;
(5) Portable boilers without regular inspection shall not be installed;
(six) shall not install and transform scrapped boilers, or transform non-pressure boilers into pressure boilers;
(seven) shall not forge, alter, transfer, lease and lend the license;
(eight) the boiler installation and renovation project shall not be subcontracted to other units without corresponding qualifications.
The installation and transformation unit shall perform the following obligations in the construction process:
(a) before the boiler installation and renovation construction, the installation and renovation unit shall fulfill the obligation to inform in accordance with the provisions;
(two) consciously accept the safety supervision of the local quality and technical supervision departments, and actively cooperate with the boiler installation and renovation supervision and inspection institutions to carry out inspections in accordance with the "Regulations" and "Rules for the Supervision and Inspection of Boiler Installation and Renovation" and other safety technical specifications;
(three) found that the boiler pressure components (components) have quality problems that affect safety, it should stop construction, report to the quality and technical supervision department of the installation location in time, and continue construction after the relevant problems are solved;
(4) Be responsible for the construction quality of installation and renovation, record the quality of boiler installation and renovation in time, properly keep the boiler data and witness data, and hand over the relevant technical data to the boiler user for archiving within 30 days after the completion acceptance.
Our unit agrees to the above provisions and promises to tell the truth. In the installation, renovation, maintenance and routine maintenance, safety will be put in the first place in strict accordance with the Regulations on Safety Supervision of Special Equipment and the above provisions.
Commitment unit _ _ _ _ _ _ _ _ _ _ _ _
Signature date of the person in charge _ _ _ _ _