a statement that the device in question conforms to the general safety and performance requirements set out in Annex I and, where applicable, indicating which general safety and performance requirements have not been fully met, together with the grounds,
ráiteas lena gcuirtear in iúl go gcomhlíonann an fheiste i gceist na ceanglais ghinearálta sábháilteachta agus feidhmíochta a leagtar amach in Iarscríbhinn I agus, i gcás inarb infheidhme, lena léirítear na ceanglais ghinearálta sábháilteachta agus feidhmíochta nár comhlíonadh ina n-iomláine, mar aon leis na forais is bonn dó sin,