Your Bluetooth Project name:
Expected Qualification Date:
Product/Design Name:
Member Company:
Product Model Number:
Hardware Version Number:
Software Version Number:
Product/Design Description:
Audit Location Address:
Company Member who will accompany the audit:
Core Version: 4.0(Low Energy only) 4.0(dual mode) 4.0+HS 3.1 3.1+HS 3.0+HS 3.0(EDR) 3.0(without EDR) 2.1+EDR 2.1 2.0+EDR 2.0
WiFi Certification No. (For design naming including +HS):
Classic Controller Power Class: Class I Class II Class III
Antenna Gain: Lower then 0.0 dBi If over 0.0 dBi à Please declare: dBi
Product Type: End Product Component (Tested) Component (Non-Tested)
Host Subsystem Controller Subsystem Profile Subsystem
Test Equipment Development Tool
* If any pre-tested components (Within 3 years) are designed to use in the EUT, QD I.D. (Could be more than one) as follows:
RF/PHY:
QD ID (for PRD v2.1)
Core Controller (BB,LM,802.11 PAL,LL):
QD ID (for PRD v2.1)
Core Host (L2CAP,SDP,GAP,A2MP):
QD ID (for PRD v2.1)
Profiles:
QD ID (for PRD v2.1)
Temperature range for RF extreme test : Max. temperature ____ Min. temperature ______
Supported Profiles: Please mark for support features
Conformance Part/ SPP / / SPP 1.2 / / SPP-A / / SPP-B /
/ AVCTP 1.0 / / AVCTP 1.2 / / AVCTP 1.3 / / AVCTP 1.4 /
/ AVDTP 1.0 / / AVDTP 1.2 / / AVDTP 1.3
/ RFCOMM / / BNEP / / MCAP / /
Application Layer/Interoperability test / 1.Choose version / 2.Choose roles
/ A2DP 1.0 / / BPP 1.0 / / HFP 1.5 / / PAN-User / / HDP
/ A2DP 1.2 / / BPP 1.2 / / HFP 1.6 / / PAN-NAP / / HDP 1.1
/ A2DP 1.3 / / BPP-Printer / / HFP-AG / / PAN-GAN / / HDP-Source
/ A2DP-Sink / / BPP-Sender / / HFP-Unit / / PBAP / / HDP-Sink
/ A2DP-Source / / DID 1.2 / / HID / / PBAP 1.1 /
/ AVRCP / / DID 1.3 / / HID 1.1 / / PBAP-PSE /
/ AVRCP 1.3 / / DUN / / HID-Dev / / PBAP-PCE /
/ AVRCP 1.4 / / DUN 1.2 / / HID-Host / / SAP1.0 /
/ AVRCP 1.5 / / DUN-DT / / HSP1.1 / / SAP1.1 /
/ AVRCP-Target / / DUN-GW / / HSP1.2 / / SAP-Client /
/ AVRCP-Controller / / FTP / / HSP-AG / / SAP-Server /
/ BIP 1.0 / / FTP 1.2 / / HSP-HS / / SDAP-LocDev /
/ BIP 1.1 / / FTP-Server / / IOPT / / Serial Profile Service
(SPP for End user) /
/ BIP 1.2 / / FTP-Client / / MAP / / SYNC /
/ BIP-ImagePushInitiator / / GAVDP 1.0 / / MAP 1.1 / / SYNC 1.2 /
/ BIP-ImagePushResponder / / GAVDP 1.2 / / MAP 1.2 / / SYNC-Client /
/ BIP-ImagePullInitiator / / GAVDP 1.3 / / MAP-Client / / SYNC-Server /
/ BIP-ImagePullResponder / / GAVDP-
Acceptor / / MAP-Server / / VDP /
/ BIP- AdvImagePrintInitiator / / GAVDP-
Initiator / / MCAP-Source / / VDP 1.1 /
/ BIP- AdvImagePrintResponder / / GNSS-Server / / MCAP-Sink / / VDP-Source /
/ BIP-AutoArchiveInitiator / / HCRP 1.0 / / OPP / / VDP-Sink /
/ BIP-AutoArchiveResponder / HCRP 1.2 / OPP 1.2 / 3DSP
/ BIP-RemCamInitiator / HCRP-Client / OPP- Client / 3DSP 1.01
/ BIP-RemCamResponder / HCRP-Server / OPP-Server / 3DSP-Display
/ BIP-RemDisplayInitiator / / / 3DSP-Glasses
/ BIP-RemDisplayResponder / / /
Supported LE Profiles: Please mark for support features
/ ANP-Client / / FMP-Target / / LLS / / TIP-Client // ANP-Server / / FMP-Locator / / LNP-LN Sensor / / TIP-Server /
/ ANS / / GLP-Sensor / / LNP-Collector / / TPS /
/ BAS / / GLP-Collector / / LNS / /
/ BLP-Collector / / GLS / / NDCS / /
/ BLP-Blood Pressure Sensor / / HOGP-HID Device / / PASP- Client / /
/ BLS / / HOGP-Report Host / / PASP-Server / /
/ CPP-Sensor / / HIDS / / PASS / /
/ CPP-Collector / / HRP-Sensor / / PXP-Reporter / /
/ CPP-CO Observer / / HRP-Collector / / PXP-Monitor / /
CPP-CP Broadcaster / / HRS / / RTUS /
CPS / / HTP-Thermometer / / RSCP-RSC Sensor /
CSCP-CSC Sensor / / HTP-Collector / / RSCP-Conllector /
CSCP-Collector / / HTS / / RSCS /
CSCS / / IAS / / SCPP-Client /
CTS / / / SCPP-Server /
DIS / / / SCPS /
Page 3of 3
TUV Rheinland Taiwan Ltd.
Rev.004