Application for Independent TÜV SÜD BABT Certification for Unintentional Radiator Using

BABT 744 Issue 5

Page 1 of 3

This application form should be used for applications where FCC filing is not required

Section A. Main Contact details

Title:...... First name: ...... Last Name: ......

(This person must be within the certificate holders organisational structure and must not be a consultant)

Job Title and/or Department Reference:......

Company Name:......

Address:......

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Postcode/Zip Code:...... Country:......

Telephone Number:...... Fax Number:......

e-mail Address:......

Section B. Details of other contacts

Normally all contact is directed through the main contact. If you wish to involve others for particular roles please advise TUV SUD BABT with their contact details and relationship with the main contact.

In particular please mark with an “X” indicate if you require any of the following and supply the supporting information

Section C. Certification Requirements

C.1 Equipment Type

Please refer to Table 1 of document BABT 743 and detail the equipment type of your product

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C.2 FCC Route

Please refer to Table 1 of document BABT 743 and confirm the Approval option that you intend using

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Section D. Product Details

D.1 Product name and details

Please give the product name(s) which are the subject of this application. Give the name and, if applicable the model or catalogue number of each product:

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BABT 744 Issue 4

Page 1 of 3

D.2 Brief 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.

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Section E. Agreement

I hereby certify that neither I nor any party to this application is subject to a denial of U.S. Federal benefits that include FCC benefits, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, U.S.C. 862 because of conviction for possession or distribution of controlled substance. Refer to Part 1 1.2002(b) for the definition of “party”.

And

I (We) hereby apply for a Certificate in relation to the specified product and agree to conform to the Certification Regulations;

Signed for on behalf of the applicant

Authorised signatory......

Name in CAPITALS...... Date ......

Company Name of Authorised signatory:......

(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.)

All work is undertaken under TUV SUD BABT’s standard terms & conditions and the following specific conditions:

• 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 to TUV SUD BABT Customer Services in writing.

A copy of TUV SUD BABT’s standard terms & conditions can be found on our website

This application form must be accompanied by the required information as detailed in BABT 743 ‘A guide to applying for independent TÜV SÜD BABT Certification of unintentional radiators using FCC Verification or Declaration of Conformity routes to US market access’.