KEN Accessory Request Form

Machine type

Load/instrument description

e.g. Lumened instruments for minimally invasive surgery

Accessory category

RackModuleInjector/nozzleOther

Samples for testing provided by

Not needed (already have)Needed but not providedOther

Cleaning test method

If applicable - e.g. 15883-5 Annex A

Segment

HealthcareLife Science

Expected annual sales

Pcs / year

Maximum cost price

(KP2) DKK

Additional requirements or information

E.g. cycle time requirements, specific detergent, temperature range, filtered cleaning, loading ergonomics etc.

Capacity requirements

If applicable

Date

DD MM YYYY

Request submitted by