Company name/Podiatrist*
E-mail address*
Which Emma shoe is used?
Shoe size
Registration code Ortho Cover*
Confirmation conditions*I have manufactured the personalized insole in accordance with the supplied work instruction. This is required in order to maintain the EN-ISO-20345:2011 and EN ISO 20347:2012 standards which are in accordance with the provisions of Council Directive 89/686/EEC*96/58/ EC and exclusively valid in combination with already certified EMMA Safety Footwear products.
Completed by*
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