Form withdraw/cancel CoC Welcome to the Withdrawal/Cancellation FormPlease note the * fields are mandatory. Organisation DetailsPlease confirm the information that CMI currently has on file for your organisation. This information will allow your request to be authorised and efficiently processed by our Team Members.Name of the Organisation*Current Point of Contact* First Last Current Email Address* Certificate DetailsScheme Applicable* Product Listing Future Friendly (ETV) Evaluation Report CertMark Type Test CodeMark Australia WaterMark Product Name*License Number*Requested Withdrawal/Cancellation Date*Next scheduled Surveillance/Expiry dateDate prior to the Surveillance/Expiry dateDate* Date Format: DD slash MM slash YYYY Changes and Supporting EvidenceSupporting Documentation*A formal letter or the company letterhead must be supplied, signed off by the point of contact or someone else appropriately authorised to cancel the certification. Allowed file types: pdf, doc, docx, xls, xlsx - Max 10 files, 1MB each. Drop files here or Accepted file types: pdf, doc, docx, xls, xlsx. AcceptanceCertMark International reserves the right to correspond with existing authorised representatives and ask for further information as deemed necessary to confirm the information supplied. 1. The undersigned warrants all information supplied is true and correct. 2. The undersigned is an approved Point of Contact. 3. The undersigned acknowledges that once a Withdrawl/Cancellation has been processed the license number is no longer able to be used and must be removed in line with the relevant scheme rules.* I confirm that I have read and agree to the conditions set forth on this form as well as the CMI Terms and Conditions. Name* First Last By typing your Full Name you legally sign this document and agree to the above.Date* Date Format: DD slash MM slash YYYY EmailThis field is for validation purposes and should be left unchanged.
