© BABT 2018 / BABT 756
Issue 10a
Page 1 of 4
Application for Industry Canada Radio Equipment Listing through BABT operating as an FCB /
Section A:Administrative Information
A. 1Applicant Information
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 Address
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.
Title:
First Name: / Last Name:
Job Title and/or Department Reference:
Company Name:
Address:
Postcode/Zip Code: / Country:
Telephone Number: / Fax Number:
Email Address:
Industry Canada Company Number {Insert “New” or “unknown” where applicable}:
A. 3Other Contact Information
Where you wish an agent to be involved with this application please tick the box and supply an agent’s letter on letterhead singed 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:
Industry Canada Company Number {Insert “New” or “unknown” where applicable}:
Section B:Your Certification Requirements
B. 1Type of Certification
Please indicate the type of Certification you require by marking the appropriate box
Single (Original application) / Reassessment (Modification/Change)
New Family (Original application) / Addition to Existing Family
Multiple Listing (Brand name) / Other (provide details in a letter)
Note 1: Use “Single” where you are submitting the first member of a Family without any accompanying members in the same app.
Note 2: Use “Addition to existing Family” where you are submitting an additional Model to a previously approved single Application
Note 3: Class 1 Permissive Changes are made under the manufacturers responsibility and should not be submitted to BABT
B. 2Related Regulatory Processes
It is an Industry Canada 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. BABT} (or direct to Industry Canada itself). In such instances the manufacturer must not upload the D of C directly but must instead send it to the FCB (or Industry Canada) 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? / Yes / No
If YES Pleaseenclosethe D of C with this application and do not up-load it directly to Industry Canada.
Section C:Product Details
C. 1Product(s) Submitted
Please enter the Product name(s), and model(s) of each product
Product or Product Family Name(s) / Model(s)
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. 3Industry Canada Code
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 / Yes / No
If yes is the module limited to use with a specified host (or hosts) / Yes / No
Where you only intend using specified hosts please list the hosts (with their Industry Canada 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. 6Ongoing Surveillance
Please indicate which ongoing surveillance option you wish to use:
Manufacture in a BABT Certified Manufacturing location (e.g. in a location with a PQC, FQA, or ISO 9001 certificate from BABT) Where this option is taken please indicate the Location and Certificate number of your manufacturing location
Location: / Certificate Number:
Under the FCB market surveillance route
C. 7Number of Radiators/Transmitters
Please complete this in full for each of the transmitters included in your product.
Generic Type of Radio (e.g GSM) / Modulations Supported / Rated RF Output Power
(add EIRP if appropriate) / Industry Canada Type of Radio Equipment / Industry Canada Specification
C. 8Features
Please list any features of the product which may have any effect upon the regulated aspects.
C. 9Accessories
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:Payment Details
Work is carried out on receipt of either payment in advance or a valid purchase order number. Clients applying directly to BABT (i.e. not through any other TUV Group office), who do not currently have approved credit facilities with either BABT or TUV Product Service UK must include a completed Credit Details Form with the application. Alternatively payment in advance is accepted. The appropriate forms may be downloaded from
Where you wish the invoice to be sent to a different person to the main contact please tick the box and provide the full details in supporting information
Where you wish to pay in advance please either provide details of your credit cardor indicate you wish to select this type of payment and contact to arrange for the payment. We regret that BABT do not accept Amex cards.
Where you select to use a purchase order please provide your company’s Purchase order number.
Section E:Summary and Agreement
The applicant named in A1 must complete this section:
I (We) hereby apply for Industry Canada Radio Equipment Approval a through BABT acting as an FCB and agree to conform to the BABT Certification Regulations;
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) agree to inform the bureau via BABT of any changes to the information submitted;
and
I authorize BABT to discuss details related to this certification with the test facility, and consultant (where I have named one) identified in this application;
BABT is theTelecommunications
Certification body of TÜV SÜD /
© BABT 2018 / BABT 756
Issue 10a
Page 1 of 4
Signed for on behalf of the applicant
Authorised Signatory:
BABT is theTelecommunications
Certification body of TÜV SÜD /
© BABT 2018 / BABT 756
Issue 10a
Page 1 of 4
Title:
First Name:
Last Name:
Company Name:
Date:
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 BABT’s standard terms & conditions and the specific conditions listed on this form
  • 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 BABT Customer Services in writing

A copy of 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 755 ‘A Guide to applying for Industry Canada Radio Equipment listing through BABT as anFCB’.
Please return your application to
BABT
Forsyth House
Churchfield Road
Walton-on-Thames
Surrey
KT12 2TD
UK
Tel: +44 (0) 1932 251200; Fax: +44 (0)1932 251201
E-Mail:
Website:
BABT is theTelecommunications
Certification body of TÜV SÜD /