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Page 2 of 12                     Report No. 60377885 001


                                                   EN 14683:2019+AC:  2019
                                                    Medical face masks  —
                                               Requirements and test methods
                 Report Reference No. ................. :   60377885 001
                 Date of issue.............................. :   See cover page

                 Total number of pages................ :   See cover page

                 Testing Laboratory ..................... :   TÜV Rheinland (Shenzhen) Co., Ltd.
                 Address..................................... :   1F East & 2-4F, Cybio Technology Building No.1, No.16 Kejibei 2nd
                                                    Road, High-Tech Industrial Park North Nanshan District, 518057,
                                                    Shenzhen, China
                 Applicant’s name ....................... :   Henan Siyuan Medical Equipment Co., Ltd

                 Address..................................... :   Industrial cluster, Huanglou Road, Shaolin Avenue, Dengfeng City,
                                                    Zhengzhou City, Henan Province, China, 452470
                 Test specification:

                 Standard.................................... :   EN 14683:2019+AC:2019
                 Test procedure........................... :   Type test
                 Non-standard test method………..:  N/A
                 Test Report Form No. ................. :   EN 14683:2019+AC:2019_A

                 Test Report Form Originator ....... :   TÜV Rh (SZ)
                 Master TRF ................................ :   2020-03
                 Test item description.................. :   Single-use medical face mask (non-sterile)
                 Trade Mark ................................ :


                 Manufacturer ............................. :   Same as the applicant
                 Model/Type reference ................. :   Flat Type(blue)
                 Classification ............................. :   Type IIR





























               QMF-RT-33008SHG                                                   Revision number: 1.0                                                  Effective date: 2020-03-12
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