工業(yè)產(chǎn)品生產(chǎn)許可證
年度監(jiān)督審查企業(yè)自查申報(bào)表
(200 年度)
產(chǎn)品名稱:__________________________________
企業(yè)名稱:__________________________________
企業(yè)代碼:__________________________________
詳細(xì)地址:__________________________________
郵政編碼:__________________________________
聯(lián) 系 人:__________________________________
聯(lián)系電話:__________________________________
填報(bào)日期: 年 月 日
全國(guó)工業(yè)產(chǎn)品生產(chǎn)許可證辦公室印制
— 1 —
填表說(shuō)明:
1、填寫要實(shí)事求是,不得弄虛作假;
2、申請(qǐng)書一律用鋼筆填官,字跡清晰、工整、不得涂改,也可以打??;
3、企業(yè)名稱要與生產(chǎn)許可證證書上的企業(yè)名稱一致;
4、產(chǎn)品名稱按《實(shí)施細(xì)則》規(guī)定的名稱填寫;
5、年產(chǎn)量、產(chǎn)值、銷售額、繳稅額、利潤(rùn)均按上年度填寫;
6、填寫附表時(shí)如空間不夠,可自行附頁(yè);
7、申請(qǐng)書封面必須加蓋企業(yè)公章;
8、該表一式二份(企業(yè)公章復(fù)印無(wú)效)。
— 2 —
企業(yè)基本情況年變化一覽表
獲證時(shí)企業(yè)名稱
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現(xiàn)企業(yè)名稱
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獲證時(shí)企業(yè)生產(chǎn)場(chǎng)地地址
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現(xiàn)企業(yè)生產(chǎn)場(chǎng)地地址
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獲證時(shí)法人代表
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現(xiàn)法人代表
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經(jīng)濟(jì)性質(zhì)
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現(xiàn)經(jīng)濟(jì)性質(zhì)
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獲證時(shí)上級(jí)主管單位
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現(xiàn)上級(jí)主管單位
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獲證時(shí)營(yíng)業(yè)執(zhí)照編號(hào)
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現(xiàn)營(yíng)業(yè)熱照編號(hào)
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獲證時(shí)企業(yè)代碼
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現(xiàn)企業(yè)代碼
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獲證時(shí)企業(yè)總?cè)藬?shù)
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現(xiàn)企業(yè)總?cè)藬?shù)
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獲證時(shí)企業(yè)技術(shù)人員數(shù)
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現(xiàn)企業(yè)技術(shù)人員數(shù)
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獲證時(shí)占地面積
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米2
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現(xiàn)占地面積
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獲證時(shí)建筑面積
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米2
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現(xiàn)建筑面積
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獲證時(shí)固定資產(chǎn)
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萬(wàn)元
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現(xiàn)固定資產(chǎn)
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萬(wàn)元
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獲證時(shí)流動(dòng)資金
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萬(wàn)元
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現(xiàn)流動(dòng)資金
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萬(wàn)元
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年總產(chǎn)值
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萬(wàn)元
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年銷售額
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萬(wàn)元
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年繳稅金額
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萬(wàn)元
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年利潤(rùn)
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萬(wàn)元
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— 3 —
企業(yè)主要負(fù)責(zé)人、工程技術(shù)骨干人員一覽表
序 號(hào)
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姓 名
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性 別
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年 齡
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職 務(wù)
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職 稱
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文化程度
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專 業(yè)
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工作崗位
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— 4 —
主要生產(chǎn)設(shè)備、工裝明細(xì)表
序號(hào)
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名 稱
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規(guī)格型號(hào)
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數(shù) 量
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完好狀態(tài)
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使用場(chǎng)所
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生 產(chǎn) 廠 及 國(guó) 別
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生產(chǎn)日期
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購(gòu)置日期
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— 5—
主要檢測(cè)設(shè)備明細(xì)表
序號(hào)
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名 稱
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規(guī)格型號(hào)
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數(shù) 量
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完好狀態(tài)
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使用場(chǎng)所
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生 產(chǎn) 廠 及 國(guó) 別
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生產(chǎn)日期
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購(gòu)置日期
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{placeholder tag=p i=442} {placeholder tag=span i=1434}主要原材料、外購(gòu)件和外協(xié)件明細(xì)表
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{placeholder tag=p i=771} {placeholder tag=span i=1771}—{placeholder tag=span i=1772}10{placeholder tag=span i=1773} —
{placeholder tag=p i=772} {placeholder tag=span i=1774}企業(yè)獲證產(chǎn)品委托加工備案情況
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{placeholder tag=p i=774} {placeholder tag=span i=1776}序號(hào)
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{placeholder tag=p i=775} {placeholder tag=span i=1777}產(chǎn)品名稱
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{placeholder tag=p i=776} {placeholder tag=span i=1778}被委托加工企業(yè)名稱
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{placeholder tag=p i=777} {placeholder tag=span i=1779}委托加工備案情況
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{placeholder tag=p i=819} {placeholder tag=span i=1821} — 1{placeholder tag=span i=1822}1{placeholder tag=span i=1823} —
{placeholder tag=p i=820} {placeholder tag=span i=1824}企業(yè)工業(yè)產(chǎn)品生產(chǎn)許可證年審自查表
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{placeholder tag=p i=822} {placeholder tag=span i=1826}企業(yè)名稱(蓋章): 填表日期: 年 月 日
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{placeholder tag=td i=2780}
{placeholder tag=p i=823} {placeholder tag=span i=1827}年審項(xiàng)目條款號(hào)
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{placeholder tag=p i=824} {placeholder tag=span i=1828}年 審 項(xiàng) 目
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{placeholder tag=p i=825} {placeholder tag=span i=1829}企業(yè)自查記錄
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{placeholder tag=p i=826} {placeholder tag=span i=1830}符合性說(shuō)明
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{placeholder tag=p i=827} {placeholder tag=span i=1831}自查人簽名
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{placeholder tag=p i=828} {placeholder tag=span i=1832}1
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{placeholder tag=p i=829} {placeholder tag=span i=1833}企業(yè)生產(chǎn)是否正常,有無(wú)連續(xù)一年以上停產(chǎn)或已轉(zhuǎn)產(chǎn)的情況
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{placeholder tag=p i=834} {placeholder tag=span i=1838}企業(yè)生產(chǎn)條件是否符合發(fā)證時(shí)的條件,有無(wú)嚴(yán)重不符合的情況
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{placeholder tag=p i=836} {placeholder tag=span i=1840}
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{placeholder tag=p i=838} {placeholder tag=span i=1842}3
{placeholder tag=td i=2796}
{placeholder tag=p i=839} {placeholder tag=span i=1843}企業(yè)質(zhì)量體系運(yùn)行是否正常、有效,有無(wú)較嚴(yán)重的管理滑坡、生產(chǎn)條件改變、質(zhì)量標(biāo)準(zhǔn)降低現(xiàn)象
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{placeholder tag=p i=843} {placeholder tag=span i=1847}4
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{placeholder tag=p i=844} {placeholder tag=span i=1848}企業(yè)有無(wú)變更名稱,是否按規(guī)定辦理生產(chǎn)許可證更名手續(xù)
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{placeholder tag=p i=848} {placeholder tag=span i=1852}5
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{placeholder tag=p i=849} {placeholder tag=span i=1853}企業(yè)有無(wú)遷址、增設(shè)生產(chǎn)場(chǎng)點(diǎn)或者生產(chǎn)條件發(fā)生較大變化,是否已辦理生產(chǎn)許可證變更手續(xù)
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{placeholder tag=p i=853} {placeholder tag=span i=1857} — {placeholder tag=span i=1858}12{placeholder tag=span i=1859} —
{placeholder tag=p i=854} {placeholder tag=span i=1860}企業(yè)工業(yè)產(chǎn)品生產(chǎn)許可證年審自查表 (續(xù))
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{placeholder tag=p i=856} {placeholder tag=span i=1862}年審項(xiàng)目條款號(hào)
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{placeholder tag=p i=857} {placeholder tag=span i=1863}年審項(xiàng)目
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{placeholder tag=p i=859} {placeholder tag=span i=1865}符合性說(shuō)明
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{placeholder tag=p i=860} {placeholder tag=span i=1866}自查人簽字
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{placeholder tag=p i=861} {placeholder tag=span i=1867}6
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{placeholder tag=p i=862} {placeholder tag=span i=1868}獲證產(chǎn)品有無(wú)增加單元、擴(kuò)增規(guī)格,是否已辦理生產(chǎn)許可證變更手續(xù)
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{placeholder tag=p i=867} {placeholder tag=span i=1873}獲證產(chǎn)品是否已按規(guī)定標(biāo)明生產(chǎn)許可證標(biāo)記和編號(hào)
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{placeholder tag=p i=871} {placeholder tag=span i=1877}8
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{placeholder tag=p i=872} {placeholder tag=span i=1878}獲證產(chǎn)品在市級(jí)上質(zhì)量監(jiān)督檢查中,有無(wú)不合格的情況
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{placeholder tag=p i=876} {placeholder tag=span i=1882}9
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{placeholder tag=p i=877} {placeholder tag=span i=1883}企業(yè)有無(wú)其他列入生產(chǎn)許可證管理但未獲證的產(chǎn)品
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{placeholder tag=p i=881} {placeholder tag=span i=1887}10
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{placeholder tag=p i=882} {placeholder tag=span i=1888}企業(yè)有無(wú)涂改、轉(zhuǎn)讓生產(chǎn)許可證、生產(chǎn)假冒偽劣產(chǎn)品或其他質(zhì)量違法行為
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{placeholder tag=p i=887} {placeholder tag=span i=1893}產(chǎn)品質(zhì)量檢驗(yàn)報(bào)告或檢驗(yàn)記錄數(shù)據(jù)與《實(shí)施細(xì)則》中相關(guān)標(biāo)準(zhǔn)的符合性
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{placeholder tag=p i=893} {placeholder tag=span i=1901}企業(yè)名稱
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{placeholder tag=p i=895} {placeholder tag=span i=1903}企業(yè)地址
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{placeholder tag=p i=897} {placeholder tag=span i=1905}產(chǎn)品名稱
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{placeholder tag=p i=899} {placeholder tag=span i=1907}郵 編
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{placeholder tag=p i=901} {placeholder tag=span i=1909}電話
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{placeholder tag=p i=903} {placeholder tag=span i=1911}申證產(chǎn)品名稱
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{placeholder tag=p i=905} {placeholder tag=span i=1913}聯(lián)系人
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{placeholder tag=p i=907} {placeholder tag=span i=1915}傳真
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{placeholder tag=p i=909} {placeholder tag=span i=1917}企業(yè)
{placeholder tag=p i=910} {placeholder tag=span i=1918}自查
{placeholder tag=p i=911} {placeholder tag=span i=1919}結(jié)論
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{placeholder tag=p i=912} {placeholder tag=span i=1920} 根據(jù)《工業(yè)產(chǎn)品生產(chǎn)許可證年度監(jiān)督審查管理規(guī)定》和《________________產(chǎn)品生產(chǎn)許可證換(發(fā))證實(shí)施細(xì)則》,本企業(yè)于________年_______月______日至______年______月______日對(duì)生產(chǎn)條件進(jìn)行了自查。經(jīng)審查本企業(yè)在上一年度內(nèi)有如下不符合:
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{placeholder tag=p i=916} {placeholder tag=span i=1924} 經(jīng)綜合評(píng)價(jià),本審查組對(duì)該企業(yè)的年審結(jié)論是:_____________________。
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{placeholder tag=p i=917} {placeholder tag=span i=1925}企業(yè)負(fù)責(zé)人簽署意見(jiàn)
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{placeholder tag=p i=923} {placeholder tag=span i=1931}企業(yè)負(fù)責(zé)人簽字(蓋章)
{placeholder tag=p i=924} {placeholder tag=span i=1932} 年 月 日
{placeholder tag=tr i=2905}
{placeholder tag=td i=2865}
{placeholder tag=p i=925} {placeholder tag=span i=1933}省級(jí)許可證辦公室年審竟見(jiàn)
{placeholder tag=td i=2866}
{placeholder tag=p i=926} {placeholder tag=span i=1934}
{placeholder tag=p i=927} {placeholder tag=span i=1935}
{placeholder tag=p i=928} {placeholder tag=span i=1936}
{placeholder tag=p i=929} {placeholder tag=span i=1937}
{placeholder tag=p i=930} {placeholder tag=span i=1938} 年 月 日(蓋章)
{placeholder tag=tr i=2906}
{placeholder tag=td i=2867}
{placeholder tag=td i=2868}
{placeholder tag=td i=2869}
{placeholder tag=td i=2870}
{placeholder tag=td i=2871}
{placeholder tag=td i=2872}
{placeholder tag=td i=2873}
{placeholder tag=p i=931} {placeholder tag=span i=1939}申證產(chǎn)品名稱填寫:產(chǎn)品名稱,用圓括弧注明申證單元,如食品電烤爐(商用電烤爐,商用旋轉(zhuǎn)爐2單元)。
{placeholder tag=p i=932} {placeholder tag=span i=1940} — {placeholder tag=span i=1941}14{placeholder tag=span i=1942}
{placeholder tag=p i=933} {placeholder tag=br i=1}
{placeholder tag=div i=4}
{placeholder tag=p i=934} {placeholder tag=span i=1943}工業(yè)產(chǎn)品生產(chǎn)許可證年度監(jiān)督審查企業(yè)自查申報(bào)表
{placeholder tag=p i=935} {placeholder tag=span i=1944}填 表 需 知
{placeholder tag=p i=936} {placeholder tag=span i=1945}一、封面
{placeholder tag=p i=937} {placeholder tag=span i=1946}產(chǎn)品名稱—按生產(chǎn)許可證實(shí)施細(xì)則上大類產(chǎn)品名稱填寫,產(chǎn)品名稱后加括號(hào)填寫申證產(chǎn)品的名稱(獲證幾個(gè)單元寫幾個(gè)單元)。如:水泥({placeholder tag=span i=1947}32.5{placeholder tag=span i=1948}普通硅酸鹽水泥)({placeholder tag=span i=1949}MSRG{placeholder tag=span i=1950}級(jí)油井水泥),又如:建筑門窗(塑料窗)(鋁合金窗)
{placeholder tag=p i=938} {placeholder tag=span i=1951}詳細(xì)地址——按申請(qǐng)表上的地址填寫。
{placeholder tag=p i=939} {placeholder tag=span i=1952}聯(lián)系人——寫兩個(gè)聯(lián)系人
{placeholder tag=p i=940} {placeholder tag=span i=1953}聯(lián)系電話——兩個(gè)聯(lián)系人的固定電話和手機(jī)號(hào)碼
{placeholder tag=p i=941} {placeholder tag=span i=1954}在企業(yè)名稱上加蓋公章
{placeholder tag=p i=942} {placeholder tag=span i=1955}二、企業(yè)基本情況年變化一覽表
{placeholder tag=p i=943} {placeholder tag=span i=1956}按實(shí)際情況填寫,數(shù)據(jù)以申報(bào)年度年終決算的數(shù)據(jù)為準(zhǔn)。
{placeholder tag=p i=944} {placeholder tag=span i=1957}三、主要生產(chǎn)設(shè)備、工裝明細(xì)表
{placeholder tag=p i=945} {placeholder tag=span i=1958}按實(shí)施細(xì)則要求的“企業(yè)必備的生產(chǎn)設(shè)備和檢測(cè)設(shè)備”填寫不得遺漏。先填寫生產(chǎn)設(shè)備,再填寫檢測(cè)設(shè)備。該表相當(dāng)于申請(qǐng)表中“主要生產(chǎn)設(shè)備、工藝裝備明細(xì)”和“主要檢測(cè)儀器、設(shè)備明細(xì)”兩表,不夠填寫可增加附頁(yè)。
{placeholder tag=p i=946} {placeholder tag=span i=1959}四、主要原材料、外購(gòu)件和外協(xié)件明細(xì)表
{placeholder tag=p i=947} {placeholder tag=span i=1960} 型號(hào)規(guī)格、年需量、標(biāo)準(zhǔn)代號(hào)均要填寫清楚。
{placeholder tag=p i=948} {placeholder tag=span i=1961}生產(chǎn)單位寫明供貨生產(chǎn)廠家全稱
{placeholder tag=p i=949} {placeholder tag=span i=1962}五、產(chǎn)品標(biāo)準(zhǔn)情況一覽表
{placeholder tag=p i=950} {placeholder tag=span i=1963}國(guó)家{placeholder tag=span i=1964}/{placeholder tag=span i=1965}行業(yè){placeholder tag=span i=1966}/{placeholder tag=span i=1967}企業(yè) 標(biāo)準(zhǔn)名稱:要寫清楚國(guó)家(或行業(yè)或企業(yè))標(biāo)準(zhǔn)及標(biāo)準(zhǔn)的名稱,如:“國(guó)家標(biāo)準(zhǔn) 普通硅酸鹽水泥”?!靶袠I(yè)標(biāo)準(zhǔn) {placeholder tag=span i=1968}PVC{placeholder tag=span i=1969}塑料窗”
{placeholder tag=p i=951} {placeholder tag=span i=1970}“獲證時(shí)標(biāo)準(zhǔn)號(hào)”和“現(xiàn)標(biāo)準(zhǔn)號(hào)”要如實(shí)填寫。
{placeholder tag=p i=952} {placeholder tag=span i=1971}六、企業(yè)生產(chǎn)場(chǎng)點(diǎn)變化情況一覽表
{placeholder tag=p i=953} {placeholder tag=span i=1972}原生產(chǎn)場(chǎng)點(diǎn)地址:按申辦生產(chǎn)許可證時(shí)生產(chǎn)場(chǎng)點(diǎn)的地址填寫
{placeholder tag=p i=954} {placeholder tag=span i=1973}現(xiàn)生產(chǎn)場(chǎng)點(diǎn)地址:按現(xiàn)在生產(chǎn)場(chǎng)點(diǎn)地址填寫,如無(wú)變化可寫“同左”
{placeholder tag=p i=955} {placeholder tag=span i=1974}生產(chǎn)場(chǎng)點(diǎn)地址變化情況:如無(wú)變化寫“無(wú)變化”,如有變化,寫清原因。
{placeholder tag=p i=956} {placeholder tag=span i=1975}七、企業(yè)獲證產(chǎn)品、申證單元、規(guī)格型號(hào)情況一覽表
{placeholder tag=p i=957} {placeholder tag=span i=1976}獲證產(chǎn)品:按大類寫,如“水泥”
{placeholder tag=p i=958} {placeholder tag=span i=1977}申請(qǐng)單元:按生產(chǎn)許可證實(shí)施細(xì)則的申證單元產(chǎn)品名稱填寫,如“普通硅酸鹽水泥”。
{placeholder tag=p i=959} {placeholder tag=span i=1978}八、企業(yè)獲證產(chǎn)品在國(guó)家或省級(jí)質(zhì)量監(jiān)督抽查、委托檢驗(yàn)、自檢中的有關(guān)情況一覽表
{placeholder tag=p i=960} {placeholder tag=span i=1979}檢驗(yàn)類別:這一欄要寫明“檢驗(yàn)類別”和“檢測(cè)單位”,根據(jù)“檢驗(yàn)報(bào)告”填寫。如“定期監(jiān)督檢驗(yàn){placeholder tag=span i=1980}/{placeholder tag=span i=1981}統(tǒng)檢(自治區(qū)質(zhì)檢所)”,“委托檢驗(yàn)(×××地區(qū)質(zhì)檢所)”。
{placeholder tag=p i=961} {placeholder tag=span i=1982}“產(chǎn)品名稱”、“合格與否”、“檢驗(yàn)日期”按檢驗(yàn)報(bào)告填寫。
{placeholder tag=p i=962} {placeholder tag=span i=1983}填寫順序按先監(jiān)督抽查,后委托檢驗(yàn),最后寫自檢。出廠產(chǎn)品由企業(yè)自檢合格的填寫一行即可,檢驗(yàn)日期應(yīng)填寫是本年度里發(fā)生的,從檢驗(yàn)的第一批產(chǎn)品到最后一批產(chǎn)品的日期。如:“{placeholder tag=span i=1984}2005.3.10~2005.12.11 {placeholder tag=span i=1985}共{placeholder tag=span i=1986}135{placeholder tag=span i=1987}批次”。如有一批次不合格,則應(yīng)另填寫一行,依次類推。
{placeholder tag=p i=963} {placeholder tag=span i=1988}該表應(yīng)加蓋地(州)質(zhì)量技術(shù)監(jiān)督局公章。如未蓋章,需提供檢驗(yàn)報(bào)告原件,供年審時(shí)審核。
{placeholder tag=p i=964} {placeholder tag=span i=1989}九、企業(yè)獲證產(chǎn)品委托加工備案情況
{placeholder tag=p i=965} {placeholder tag=span i=1990}按實(shí)際情況填寫
{placeholder tag=p i=966} {placeholder tag=span i=1991}十、企業(yè)工業(yè)產(chǎn)品生產(chǎn)許可證年審自查表
{placeholder tag=p i=967} {placeholder tag=span i=1992} 企業(yè)名稱:填寫清楚并加蓋公章
{placeholder tag=p i=968} {placeholder tag=span i=1993}企業(yè)自查記錄:應(yīng)按“年審項(xiàng)目”詳細(xì)認(rèn)真回答,不能寫“無(wú)”、“有”、“是”等。
{placeholder tag=p i=969} {placeholder tag=span i=1994}符合性說(shuō)明一欄寫“符合”或“不符合”
{placeholder tag=p i=970} {placeholder tag=span i=1995}十一、工業(yè)產(chǎn)品生產(chǎn)許可證獲證企業(yè)年度監(jiān)督審查報(bào)告
{placeholder tag=p i=971} {placeholder tag=span i=1996}產(chǎn)品名稱:生產(chǎn)許可證實(shí)施細(xì)則的大類填寫,如“水泥”“建筑外窗”“白酒”
{placeholder tag=p i=972} {placeholder tag=span i=1997}申證產(chǎn)品名稱:按申證單元的名稱填寫,如“普通硅酸鹽水泥”
{placeholder tag=p i=973} {placeholder tag=span i=1998}企業(yè)自查結(jié)論:時(shí)間按自查的實(shí)際工作日期填寫。(一般在三天內(nèi)就可搞定)
{placeholder tag=p i=974} {placeholder tag=span i=1999}經(jīng)審查本企業(yè)在上一年度如下不符合:根據(jù)年審自查表中不符合項(xiàng)填寫。如全部符合則填寫“無(wú)”,結(jié)論填寫“合格”,否則填寫“不合格”。
{placeholder tag=p i=975} {placeholder tag=span i=2000}企業(yè)負(fù)責(zé)人簽署意見(jiàn):負(fù)責(zé)人簽署意見(jiàn)“同意上報(bào)”并簽名加蓋企業(yè)公章。
{placeholder tag=p i=976} {placeholder tag=span i=2001}十二、年審企業(yè)應(yīng)報(bào)以下材料,并帶生產(chǎn)許可證副本。
{placeholder tag=p i=977} {placeholder tag=span i=2002}1{placeholder tag=span i=2003}、自查申報(bào)表{placeholder tag=span i=2004}2{placeholder tag=span i=2005}份 {placeholder tag=span i=2006}2{placeholder tag=span i=2007}、企業(yè)營(yíng)業(yè)執(zhí)照復(fù)印件{placeholder tag=span i=2008}1{placeholder tag=span i=2009}份(加蓋企業(yè)公章)
{placeholder tag=p i=978} {placeholder tag=span i=2010}3{placeholder tag=span i=2011}、組織機(jī)構(gòu)代碼證復(fù)印件{placeholder tag=span i=2012}1{placeholder tag=span i=2013}份 {placeholder tag=span i=2014}4.{placeholder tag=span i=2015}、{placeholder tag=span i=2016}QS{placeholder tag=span i=2017}標(biāo)志使用說(shuō)明及使用試樣一份。
{placeholder tag=p i=979} {placeholder tag=span i=2018}十三、獲證企業(yè)對(duì)填報(bào)“工業(yè)生產(chǎn)許可證年度監(jiān)督審查企業(yè)自查申報(bào)表”的真實(shí)性負(fù)責(zé)。