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Welcome to the Withdrawal/Cancellation Form
Please note the * fields are mandatory.
Organisation Details
Please 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 Details
Scheme 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 date
Date prior to the Surveillance/Expiry date
Date
*
DD slash MM slash YYYY
Changes and Supporting Evidence
Supporting 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
Select files
Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 1 MB, Max. files: 10.
Acceptance
CertMark 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
*
DD slash MM slash YYYY
Phone
This field is for validation purposes and should be left unchanged.
