The statement should be tied to a clearly identified product family or model set and to the specific applicable security requirements. It should not be a generic brand declaration detached from the actual product version and support commitment.
Schedule 4 requires enough detail to identify the product and the responsible business: product type and batch or serial number, manufacturer name and address, any authorised representative name and address, the manufacturer's compliance declaration, the defined support period that was correct when the manufacturer first supplied the product, and the signatory and issue details.
That is what makes later evidence retrieval possible.