/ EMVCo Terminal Type Approval
Contactless Product for Standard or Optimized Process
Request For Approval / Initial / Subsequent / Renewal

Please return the completed and signed form to:

Date: insert date

Our company has developed and tested the contactless Productwith the following identification according to EMVCo defined requirements. Therefore, we submit this request for test result evaluation and type approval consideration.

Please send us a type approval invoice based on the below information.

EMVCo Product Provider Registration Number / insert Product Provider Registration Number
Company Name / insert Company Name
Modular Label Reference / insert the reference (if applicable)
Product Name & Model / insert the Product Name & Model
Contactless Process followed / <Select>StandardOptimized
Product status / <Select>InitialSubsequentSubsequent with extended dateDerivative ProductRenewal
Note: Subsequent Submission with Contactless Kernel C-REGX is only possible without Extended Date.
Tested at Main Laboratory / insert accredited laboratory name
2ndLaboratory (if any) / insert accredited laboratory name
3rdLaboratory (if any) / insert accredited laboratory name
4thLaboratory (if any) / insert accredited laboratory name
5th Laboratory (if any) / insert accredited laboratory name
6th Laboratory (if any) / insert accredited laboratory name
7th Laboratory (if any) / insert accredited laboratory name
EMVCo Contactless Product ICS Reference / insert the ICS reference
EMVCo C-1 ICS Reference (if present) / insert the ICS reference
EMVCo C-2 ICS Reference (if present) / insert the ICS reference
EMVCo C-3 ICS Reference (if present) / insert the ICS reference
EMVCo C-4 ICS Reference (if present) / insert the ICS reference
EMVCo C-5 ICS Reference (if present) / insert the ICS reference
EMVCo C-6 ICS Reference (if present) / insert the ICS reference
EMVCo C-7 ICS Reference (if present) / insert the ICS reference
EMV Contactless Specification Version
Book A – Architecture & General Requirements / insert specification date and version #
Book B – Entry Point / insert specification date and version #
Book C-1 Specification (if present) / insert specification date and version #
Book C-2 Specification (if present) / insert specification date and version #
Book C-3 Specification (if present) / insert specification date and version #
Book C-4 Specification (if present) / insert specification date and version #
Book C-5 Specification (if present) / insert specification date and version #
Book C-6 Specification (if present) / insert specification date and version #
Book C-7 Specification (if present) / insert specification date and version #

√ We hereby agree with the reports content as will be submitted by the above mentioned laboratories.

√ The ICSs appended to the reports truly reflects the capabilities of our Product.

A copy of all required documentation as listed in the “EMVCo Type Approval – ContactlessProduct – Administrative Process” documentation is attached for evaluation by EMVCo.

Conformance Declaration For Performance Requirements of Kernel(s) <C-1/C-2/C-3/C-4/C-5/C-6/C-7

We declare herewith that the Product described in the above referenced Contactless Product ICS contains the Kernel(s) with the checksum value(s) declared in the ICS and our implementation of those kernels in the Product submitted for Type Approval complies with the “EMV Contactless Specifications for Payment Systems – Book A – Architecture and General Requirements, Requirements 10.3.1.1 and 10.3.2.1.

Sincerely,

Name:insert name

Position:insert position

Signature:

V26_170202Copyright ©2017EMVCo, LLC. All rights reserved. Page 1 / 2

IFM Request for Approval