# Commission Decision of 14 December 2004 laying down guidelines for the notification of dangerous consumer products to the competent authorities of the Member States by producers and distributors, in accordance with Article 5(3) of Directive 2001/95/EC of the European Parliament and of the Council (notified under document number C(2004) 4772) (Text with EEA relevance) (2004/905/EC), Appendix ANNEX I

Extent: E+W+S+N.I.

Notification form for the notification of dangerous products to the authorities by producers or distributors
Section 1: Details of authority(ies)/company(ies) receiving the notification form
Authority/contact name/address/telephone/fax/e-mail/website
Identification of the companies notified and their role in the marketing of the product
Section 2: Details of producer/distributor
Producer or producer’s representative/distributor completing the form
Contact name/responsibility/address/telephone/fax/e-mail/website
Section 3: Details of products involved
Category. Brand or trademark. Model name(s) or bar code/CN tariff. Country of origin
Description/photograph
Section 4: Details of hazard
Description of the hazard and possible health/safety damages and conclusions of the risk estimation and evaluation carried out
Record of accident(s)
Section 5: Details of corrective actions already taken
Types/scope/duration of action(s) and precautions taken and identification of the company responsible
Companies should complete and send Section 6 in case of a serious risk or when the producer/distributor opts to submit the notification only to the authority of the Member State in which they are established
Section 6: Details of other company(ies) in the supply chain which hold affected products
List of manufacturers, importers or authorised representatives by Member State (name/address/telephone/fax/e-mail/website)
List of distributors or retailers by Member State (name/address/telephone/fax/e-mail/website)
Number of products (serial numbers or date codes) held by producer/importer/distributor/retailer/consumers by Member State

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Source: https://www.legislation.gov.uk/eudn/2004/905/annex/annex/I (the official version)
Page: https://openlegislation.uk/eu-decision-2004-905/annex/annex-I
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.