工业产品生产许可证

年度监督审查企业自查申报表

（200 年度）

产品名称：__________________________________

企业名称：__________________________________

企业代码：__________________________________

详细地址：__________________________________

邮政编码：__________________________________

联 系 人：__________________________________

联系电话：__________________________________

填报日期： 年        月        日

全国工业产品生产许可证办公室印制

— 1 —

填表说明：

1、填写要实事求是，不得弄虚作假；

2、申请书一律用钢笔填官，字迹清晰、工整、不得涂改，也可以打印；

3、企业名称要与生产许可证证书上的企业名称一致；

4、产品名称按《实施细则》规定的名称填写；

5、年产量、产值、销售额、缴税额、利润均按上年度填写；

6、填写附表时如空间不够，可自行附页；

7、申请书封面必须加盖企业公章；

8、该表一式二份（企业公章复印无效）。

— 2 —

企业基本情况年变化一览表

获证时企业名称
现企业名称
获证时企业生产场地地址
现企业生产场地地址
获证时法人代表		现法人代表
经济性质		现经济性质
获证时上级主管单位		现上级主管单位
获证时营业执照编号		现营业热照编号
获证时企业代码		现企业代码
获证时企业总人数		现企业总人数
获证时企业技术人员数		现企业技术人员数
获证时占地面积	米2	现占地面积
获证时建筑面积	米2	现建筑面积
获证时固定资产	万元	现固定资产	万元
获证时流动资金	万元	现流动资金	万元
年总产值	万元	年销售额	万元
年缴税金额	万元	年利润	万元

— 3 —

企业主要负责人、工程技术骨干人员一览表

序  号	姓  名	性  别	年  龄	职  务	职  称	文化程度	专  业	工作岗位

— 4 —

主要生产设备、工装明细表

序号	名        称	规格型号	数 量	完好状态	使用场所	生 产 厂 及 国 别	生产日期	购置日期

— 5—

主要检测设备明细表

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序号	名        称	规格型号	数 量	完好状态	使用场所	生 产 厂 及 国 别	生产日期	购置日期
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{placeholder tag=td i=2775} {placeholder tag=p i=813} {placeholder tag=span i=1815}

{placeholder tag=td i=2776} {placeholder tag=p i=814} {placeholder tag=span i=1816}

{placeholder tag=td i=2777} {placeholder tag=p i=815} {placeholder tag=span i=1817}

{placeholder tag=td i=2778} {placeholder tag=p i=816} {placeholder tag=span i=1818}

{placeholder tag=td i=2779} {placeholder tag=p i=817} {placeholder tag=span i=1819}

{placeholder tag=p i=818} {placeholder tag=span i=1820}

{placeholder tag=p i=819} {placeholder tag=span i=1821} — 1{placeholder tag=span i=1822}1{placeholder tag=span i=1823} —

{placeholder tag=p i=820} {placeholder tag=span i=1824}企业工业产品生产许可证年审自查表

{placeholder tag=p i=821} {placeholder tag=span i=1825}

{placeholder tag=p i=822} {placeholder tag=span i=1826}企业名称（盖章）：　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　填表日期：　　　年　月　日

{placeholder tag=table i=2029} {placeholder tag=td i=2780} {placeholder tag=p i=823} {placeholder tag=span i=1827}年审项目条款号

{placeholder tag=td i=2781} {placeholder tag=p i=824} {placeholder tag=span i=1828}年　审　项　目

{placeholder tag=td i=2782} {placeholder tag=p i=825} {placeholder tag=span i=1829}企业自查记录

{placeholder tag=td i=2783} {placeholder tag=p i=826} {placeholder tag=span i=1830}符合性说明

{placeholder tag=td i=2784} {placeholder tag=p i=827} {placeholder tag=span i=1831}自查人签名

{placeholder tag=td i=2785} {placeholder tag=p i=828} {placeholder tag=span i=1832}1

{placeholder tag=td i=2786} {placeholder tag=p i=829} {placeholder tag=span i=1833}企业生产是否正常，有无连续一年以上停产或已转产的情况

{placeholder tag=td i=2787} {placeholder tag=p i=830} {placeholder tag=span i=1834}

{placeholder tag=td i=2788} {placeholder tag=p i=831} {placeholder tag=span i=1835}

{placeholder tag=td i=2789} {placeholder tag=p i=832} {placeholder tag=span i=1836}

{placeholder tag=td i=2790} {placeholder tag=p i=833} {placeholder tag=span i=1837}2

{placeholder tag=td i=2791} {placeholder tag=p i=834} {placeholder tag=span i=1838}企业生产条件是否符合发证时的条件，有无严重不符合的情况

{placeholder tag=td i=2792} {placeholder tag=p i=835} {placeholder tag=span i=1839}

{placeholder tag=td i=2793} {placeholder tag=p i=836} {placeholder tag=span i=1840}

{placeholder tag=td i=2794} {placeholder tag=p i=837} {placeholder tag=span i=1841}

{placeholder tag=td i=2795} {placeholder tag=p i=838} {placeholder tag=span i=1842}3

{placeholder tag=td i=2796} {placeholder tag=p i=839} {placeholder tag=span i=1843}企业质量体系运行是否正常、有效，有无较严重的管理滑坡、生产条件改变、质量标准降低现象

{placeholder tag=td i=2797} {placeholder tag=p i=840} {placeholder tag=span i=1844}

{placeholder tag=td i=2798} {placeholder tag=p i=841} {placeholder tag=span i=1845}

{placeholder tag=td i=2799} {placeholder tag=p i=842} {placeholder tag=span i=1846}

{placeholder tag=td i=2800} {placeholder tag=p i=843} {placeholder tag=span i=1847}4

{placeholder tag=td i=2801} {placeholder tag=p i=844} {placeholder tag=span i=1848}企业有无变更名称，是否按规定办理生产许可证更名手续

{placeholder tag=td i=2802} {placeholder tag=p i=845} {placeholder tag=span i=1849}

{placeholder tag=td i=2803} {placeholder tag=p i=846} {placeholder tag=span i=1850}

{placeholder tag=td i=2804} {placeholder tag=p i=847} {placeholder tag=span i=1851}

{placeholder tag=td i=2805} {placeholder tag=p i=848} {placeholder tag=span i=1852}5

{placeholder tag=td i=2806} {placeholder tag=p i=849} {placeholder tag=span i=1853}企业有无迁址、增设生产场点或者生产条件发生较大变化，是否已办理生产许可证变更手续

{placeholder tag=td i=2807} {placeholder tag=p i=850} {placeholder tag=span i=1854}

{placeholder tag=td i=2808} {placeholder tag=p i=851} {placeholder tag=span i=1855}

{placeholder tag=td i=2809} {placeholder tag=p i=852} {placeholder tag=span i=1856}

{placeholder tag=p i=853} {placeholder tag=span i=1857} — {placeholder tag=span i=1858}12{placeholder tag=span i=1859} —

{placeholder tag=p i=854} {placeholder tag=span i=1860}企业工业产品生产许可证年审自查表     （续）

{placeholder tag=p i=855} {placeholder tag=span i=1861}企业名称（盖章）：                                                                   填表日期：   年   月    日

{placeholder tag=table i=2030} {placeholder tag=td i=2810} {placeholder tag=p i=856} {placeholder tag=span i=1862}年审项目条款号

{placeholder tag=td i=2811} {placeholder tag=p i=857} {placeholder tag=span i=1863}年审项目

{placeholder tag=td i=2812} {placeholder tag=p i=858} {placeholder tag=span i=1864}企业自查记录

{placeholder tag=td i=2813} {placeholder tag=p i=859} {placeholder tag=span i=1865}符合性说明

{placeholder tag=td i=2814} {placeholder tag=p i=860} {placeholder tag=span i=1866}自查人签字

{placeholder tag=td i=2815} {placeholder tag=p i=861} {placeholder tag=span i=1867}6

{placeholder tag=td i=2816} {placeholder tag=p i=862} {placeholder tag=span i=1868}获证产品有无增加单元、扩增规格，是否已办理生产许可证变更手续

{placeholder tag=td i=2817} {placeholder tag=p i=863} {placeholder tag=span i=1869}

{placeholder tag=td i=2818} {placeholder tag=p i=864} {placeholder tag=span i=1870}

{placeholder tag=td i=2819} {placeholder tag=p i=865} {placeholder tag=span i=1871}

{placeholder tag=td i=2820} {placeholder tag=p i=866} {placeholder tag=span i=1872}7

{placeholder tag=td i=2821} {placeholder tag=p i=867} {placeholder tag=span i=1873}获证产品是否已按规定标明生产许可证标记和编号

{placeholder tag=td i=2822} {placeholder tag=p i=868} {placeholder tag=span i=1874}

{placeholder tag=td i=2823} {placeholder tag=p i=869} {placeholder tag=span i=1875}

{placeholder tag=td i=2824} {placeholder tag=p i=870} {placeholder tag=span i=1876}

{placeholder tag=td i=2825} {placeholder tag=p i=871} {placeholder tag=span i=1877}8

{placeholder tag=td i=2826} {placeholder tag=p i=872} {placeholder tag=span i=1878}获证产品在市级上质量监督检查中，有无不合格的情况

{placeholder tag=td i=2827} {placeholder tag=p i=873} {placeholder tag=span i=1879}

{placeholder tag=td i=2828} {placeholder tag=p i=874} {placeholder tag=span i=1880}

{placeholder tag=td i=2829} {placeholder tag=p i=875} {placeholder tag=span i=1881}

{placeholder tag=td i=2830} {placeholder tag=p i=876} {placeholder tag=span i=1882}9

{placeholder tag=td i=2831} {placeholder tag=p i=877} {placeholder tag=span i=1883}企业有无其他列入生产许可证管理但未获证的产品

{placeholder tag=td i=2832} {placeholder tag=p i=878} {placeholder tag=span i=1884}

{placeholder tag=td i=2833} {placeholder tag=p i=879} {placeholder tag=span i=1885}

{placeholder tag=td i=2834} {placeholder tag=p i=880} {placeholder tag=span i=1886}

{placeholder tag=td i=2835} {placeholder tag=p i=881} {placeholder tag=span i=1887}10

{placeholder tag=td i=2836} {placeholder tag=p i=882} {placeholder tag=span i=1888}企业有无涂改、转让生产许可证、生产假冒伪劣产品或其他质量违法行为

{placeholder tag=td i=2837} {placeholder tag=p i=883} {placeholder tag=span i=1889}

{placeholder tag=td i=2838} {placeholder tag=p i=884} {placeholder tag=span i=1890}

{placeholder tag=td i=2839} {placeholder tag=p i=885} {placeholder tag=span i=1891}

{placeholder tag=td i=2840} {placeholder tag=p i=886} {placeholder tag=span i=1892}11

{placeholder tag=td i=2841} {placeholder tag=p i=887} {placeholder tag=span i=1893}产品质量检验报告或检验记录数据与《实施细则》中相关标准的符合性

{placeholder tag=td i=2842} {placeholder tag=p i=888} {placeholder tag=span i=1894}

{placeholder tag=td i=2843} {placeholder tag=p i=889} {placeholder tag=span i=1895}

{placeholder tag=td i=2844} {placeholder tag=p i=890} {placeholder tag=span i=1896}

{placeholder tag=p i=891} {placeholder tag=span i=1897} — {placeholder tag=span i=1898}13{placeholder tag=span i=1899} —

{placeholder tag=p i=892} {placeholder tag=span i=1900}工业产品生产许可证获证企业年度监督审查报告

{placeholder tag=table i=2031} {placeholder tag=td i=2845} {placeholder tag=p i=893} {placeholder tag=span i=1901}企业名称

{placeholder tag=td i=2846} {placeholder tag=p i=894} {placeholder tag=span i=1902}

{placeholder tag=td i=2847} {placeholder tag=p i=895} {placeholder tag=span i=1903}企业地址

{placeholder tag=td i=2848} {placeholder tag=p i=896} {placeholder tag=span i=1904}

{placeholder tag=td i=2849} {placeholder tag=p i=897} {placeholder tag=span i=1905}产品名称

{placeholder tag=td i=2850} {placeholder tag=p i=898} {placeholder tag=span i=1906}

{placeholder tag=td i=2851} {placeholder tag=p i=899} {placeholder tag=span i=1907}邮  编

{placeholder tag=td i=2852} {placeholder tag=p i=900} {placeholder tag=span i=1908}

{placeholder tag=td i=2853} {placeholder tag=p i=901} {placeholder tag=span i=1909}电话

{placeholder tag=td i=2854} {placeholder tag=p i=902} {placeholder tag=span i=1910}

{placeholder tag=td i=2855} {placeholder tag=p i=903} {placeholder tag=span i=1911}申证产品名称

{placeholder tag=td i=2856} {placeholder tag=p i=904} {placeholder tag=span i=1912}

{placeholder tag=td i=2857} {placeholder tag=p i=905} {placeholder tag=span i=1913}联系人

{placeholder tag=td i=2858} {placeholder tag=p i=906} {placeholder tag=span i=1914}

{placeholder tag=td i=2859} {placeholder tag=p i=907} {placeholder tag=span i=1915}传真

{placeholder tag=td i=2860} {placeholder tag=p i=908} {placeholder tag=span i=1916}

{placeholder tag=tr i=2903} {placeholder tag=td i=2861} {placeholder tag=p i=909} {placeholder tag=span i=1917}企业

{placeholder tag=p i=910} {placeholder tag=span i=1918}自查

{placeholder tag=p i=911} {placeholder tag=span i=1919}结论

{placeholder tag=td i=2862} {placeholder tag=p i=912} {placeholder tag=span i=1920} 根据《工业产品生产许可证年度监督审查管理规定》和《________________产品生产许可证换（发）证实施细则》，本企业于________年_______月______日至______年______月______日对生产条件进行了自查。经审查本企业在上一年度内有如下不符合：

{placeholder tag=p i=913} {placeholder tag=span i=1921}

{placeholder tag=p i=914} {placeholder tag=span i=1922}

{placeholder tag=p i=915} {placeholder tag=span i=1923}

{placeholder tag=p i=916} {placeholder tag=span i=1924} 经综合评价，本审查组对该企业的年审结论是：_____________________。

{placeholder tag=td i=2863} {placeholder tag=p i=917} {placeholder tag=span i=1925}企业负责人签署意见

{placeholder tag=tr i=2904} {placeholder tag=td i=2864} {placeholder tag=p i=918} {placeholder tag=span i=1926}

{placeholder tag=p i=919} {placeholder tag=span i=1927}

{placeholder tag=p i=920} {placeholder tag=span i=1928}

{placeholder tag=p i=921} {placeholder tag=span i=1929}

{placeholder tag=p i=922} {placeholder tag=span i=1930}

{placeholder tag=p i=923} {placeholder tag=span i=1931}企业负责人签字（盖章）

{placeholder tag=p i=924} {placeholder tag=span i=1932} 年   月   日

{placeholder tag=tr i=2905} {placeholder tag=td i=2865} {placeholder tag=p i=925} {placeholder tag=span i=1933}省级许可证办公室年审竟见

{placeholder tag=td i=2866} {placeholder tag=p i=926} {placeholder tag=span i=1934}

{placeholder tag=p i=927} {placeholder tag=span i=1935}

{placeholder tag=p i=928} {placeholder tag=span i=1936}

{placeholder tag=p i=929} {placeholder tag=span i=1937}

{placeholder tag=p i=930} {placeholder tag=span i=1938} 年    月    日（盖章）

{placeholder tag=tr i=2906} {placeholder tag=td i=2867} {placeholder tag=td i=2868} {placeholder tag=td i=2869} {placeholder tag=td i=2870} {placeholder tag=td i=2871} {placeholder tag=td i=2872} {placeholder tag=td i=2873} {placeholder tag=p i=931} {placeholder tag=span i=1939}申证产品名称填写：产品名称，用圆括弧注明申证单元，如食品电烤炉（商用电烤炉，商用旋转炉2单元）。

{placeholder tag=p i=932} {placeholder tag=span i=1940} — {placeholder tag=span i=1941}14{placeholder tag=span i=1942}