*** SAMPLE DOCUMENT - FICTIONAL - NOT A REAL DECLARATION ***

EC DECLARATION OF CONFORMITY

Manufacturer:   Manufacturer X (sample)

Machine:        Electric scissor lift
Model:          SAMPLE-10E
Serial No.:     SAMPLE-0042
Year:           2023

We declare that the machine described above complies with the
relevant provisions of Directive 2006/42/EC (Machinery).

Place and date: (sample), 03.04.2023

Signed for the manufacturer: (signature)       SAMPLE