Issue 18
Page 1 of 5
Application for Canadian Radio Equipment Listing through TUV SUD BABT operating as an FCB /
Note: References to ISED refer to Innovation, Science, and Economic Development Canada
Section A:Administrative InformationA. 1Applicant Information
Note: The Certificate is issued to this company and must be the same as listed for the Canadian Company number
Title:
First Name: / Last Name:
Job Title and/or Department Reference:
Legal Business Name:
Address:
Postcode/Zip Code: / Country:
Telephone Number: / Fax Number:
Email Address:
A. 2Canadian Representative
Please mark the box and proceed to Section A.3 if the Canadian Representative information is the same as the Applicant in Section A.1 and the applicant is located in Canada.
Where you have not selected the above box please check/tick this box to confirm you have included an agreement letter from your Canadian Representative
ISED Company Number {if Applicant is Not based in Canada}:
A. 3Other Contact Information
Where you wish an agent to be involved with this application please check/tick the box and supply an agent’s letter on letterhead signed by an employee/official of the applicant company.
A. 4Manufacturer Information
Please mark the box and proceed to Section B if the Manufacturer information is the same as the Applicant in Section A.1.
Title:
First Name: / Last Name:
Job Title and/or Department Reference:
Company Name:
Address:
Postcode/Zip Code: / Country:
Telephone Number: / Fax Number:
Email Address:
ISED Company Number:
Section B:Your Certification Requirements
B. 1Type of Certification
Please indicate the type of Certification you require by marking the appropriate box
New Certification / Class II Change
Class III Change / Class IV Change
New Family Certification / Add New Product to Existing Certification
Multiple Listing (Brand name) / Transfer of Certification
Note 1: Use “New Certification” where you are submitting the first member of a Family without any accompanying members in the same app.
Note 2: Use “Add New Product to Existing Certification” where you are submitting an additional Model to a previously approved New Certification
Note 3: Class 1 Changes are made under the manufacturer’s responsibility and should not be submitted to TUV SUD BABT
Note 4: Class 2 Changes are made for minor hardware modifications to a certified/registered product which affect the RF and/or Terminal characteristics without adding new frequency bands / technologies
Note 5: Class 3 Changes are used for firmware changes affecting the RF or Terminal characteristics. New bands can be added if no HW changes
Note 6: Class 4 Changes are used for module integration into hosts.
B. 2Related Regulatory Processes
It is an ISED requirement that where a product is telecommunications terminal equipment the manufacturer must establish compliance to CS-03 and issue a Declaration of Conformity for the product.
Where the product also includes a Radio Transmitter it requires approval via a FCB (e.g. TUV SUD BABT, or direct to ISED itself). In such instances the manufacturer must not upload the D of C directly but must instead send it to the FCB (or ISED) to file in parallel with the Radio Approval Information.
Please complete the following as appropriate:
Does the product have a telecommunication port (or ports), which is subject to the requirement to register a Declaration of Conformity? / selectYesNo
If YES Please enclose the D of C with this application and do not up-load it directly to ISED.
Section C:Product Details
C. 1Product(s) Submitted
Please enter the Product name(s), and model(s) of each product
Product Marketing Name(s) (PMN)
<Note: PMN can be same as HVIN> / Hardware Version
Identification No. (HVIN)
<Note if there is no HVIN relating to the RF hardware, then can use the PMN or other identifier> / Firmware Version
Identification No. (FVIN)
<Note if there is no FVIN for to the radio or product firmware, then please list “N/A”
C. 2Brief Description of this Product
Please give brief details of the purpose and type of the product. This is intended to assist in correlating the requested certification with the standards requested and degree of testing needed.
C. 3ISED Certification Number
Company Number (up to 6 characters) / Unique Product Number [up to 11 characters(A-Z, 0-9)]
-
C. 4Product Installation Category
Please indicate the type of installation intended for your product. (Select only one)
Fixed Intentional Radiator / Mobile Intentional radiator / Portable Intentional Radiator
C. 5Radio Modules
Please complete these as appropriate
Is the equipment in this application a radio module intended for use in other products / selectNoYes Module
If yes is the module limited to use with a specified host (or hosts) / selectModular ApprovalLimited Modular ApprovalYes Module
Where you only intend using specified hosts please list the hosts HMN [ Host Marketing Name] (with their ISED ICs where appropriate)
Note: Please indicate where an application for an approval for a specified host is in progress or has not yet been submitted
C. 6Number of Radiators/Transmitters
Please complete this in full for each of the transmitters included in your product.
Where you are submitting an application for an equipment modification list all transmitters in the product, and select the “Modified” box indicate those changed/retested.
If the product has more than 14 transmitter variations please provide a complete list detailing all the required information. For modifications please list all transmitters but indicate which have been modified. Please list the identity of the document in the first entry line.
Modified / Operating Mode
(e.g. GSM) / RF Output Power
(W) / ISEDType
of Radio Equipment / ISED
Standard
C. 7Features
Please list any features of the product which may have any effect upon the regulated aspects.
C. 8Accessories
Please list any accessories which are supplied with (or for use with) your product which may have any effect upon the regulated aspects (e.g. Headsets Alternate Batteries)
Section D:Summary and Agreement
The applicant named in A1 must complete this section:
I (We) hereby apply for Innovation, Science, and Economic Development Canada Radio Equipment Approval a through TUV SUD BABT acting as an FCB and agree to conform to the TUV SUD BABT Certification Regulations; (A copy of which may be found on and
I (we) agree to meet all the requirements in accordance with Radio Standards Procedure 100 and other applicable procedures; and
I (we) warrant that the test results submitted are a true representation of the characteristics of the radio equipment type for which certification is requested ; and
I (We) declare that the Technical file supporting this application has been agreed by the manufacturer who
accepts the on-going responsibility for its maintenance; and
I (We) declare that that we have the rights to make use of all Trade names referenced in this application and supporting documentation; and
I (we) agree to provide a sample of this product for market surveillance purposes on request from either TUV SUD BABT or ISEDand agree to reimburse TUV SUD BABT any fees associated with collection, testing, and reporting of surveillance samples
and
I (we) agree to inform the bureau via TUV SUD BABT of any changes to the information submitted;
and
I authorize TUV SUD BABT to discuss details related to this certification with the test facility, and consultant (where I have named one) identified in this application
Please select this box if you do not wish to receive a paper copy of the Certificate
( Where you select this we will only send you an electronic copy of the Certificate)
TUV SUD BABT is a Certification body of TÜV SÜD /
© TUV SUD BABT 2016 / BABT 756
Issue 18
Page 1 of 5
Signed for on behalf of the applicant
Authorised Signatory: / Date:.Click here to enter a date.
Title: / First Name: / Last Name:
Company Name:
Where the application form or modification request is signed by an authorised representative instead of a member of the applicant company a letter from the applicant company appointing them must be included with the request.
- Certificates only relate to the product and build level of that product identified in the certificate.
- Certificates are not transferable.
- Changes to the Holders name or address must be notified in writing via the TÜV SÜD office to whom you sent this application
This application may be made while you prepare the required information as detailed in BABT 755 ‘A Guide to applying forCanadian Radio Equipment listing through TUV SUD BABT as anFCB’. However the review will not commence until all the required information has been supplied.
Please return your application to your local TÜV SÜD office / Alternately if you do not know your local office please return your application to:
, / TÜV SÜD Product Service,
Octagon House,
Concorde Way,
Segensworth North,
Fareham
Hampshire,
PO15 5RL,
United Kingdom
Tel: +44 (0)1489 558234;
Fax: +44 (0)1489 558101
E-Mail:
Website:
TUV SUD BABT is a Certification body of TÜV SÜD /