To: Japan Radio Law Certification Laboratory Co., Ltd

JRLC-LAB

(Form 2-1)

Power of Attorney

Date

To: Japan Radio Law Certification Laboratory Co., Ltd.

Name of person delegating / Address
Company Name
Name / Signature

I hereby entrust and delegate the following person to be a proxy for all the authorities concerned with the application for Type Certification:

Note

1. / Name/model type of
the equipment
to be entrusted
2 / Name of person delegated /entrusted / Address
Company name
Name

(Form2-2)

Letter of Administrative Attorney

Date

To: Japan Radio Law Certification Laboratory Co., Ltd.

Applicant / Address
Company name
Name of representative
Name of Manger-in-charge
Department / Sign

I hereby entrust the following person to be a proxy/agent regarding the application for Type Certification.

Regarding the contents of the application documents, I, as the applicant, will be thoroughly responsible.

Note

1. / Name or model type of the specified radio equipment:
2. / Agent / Company address:
Company name:
Name of representative:
Name of manager-in-charge:
Department:

Signature

(Form2-3)

Application for Type Certification

Date

To: Japan Radio Law Certification Laboratory Co., Ltd.

Applicant / Address
Name of Representative
Company name
Name of Manager-in-charge
Department / Signature

I hereby apply for type certification of the specified radio equipment, details described below, with required documents as attached hereto.

Regarding the contents of the application documents, I, as the applicant, will be thoroughly responsible.

Classification

Model Name
Name of Manufacturer
Type of emission, frequency, and antenna power desired for certification
Remarks

(Form2-4)

Annex to Application for Type Certification

１．Submission of the product / □ Yes □ No
2. Telecommunication network connection / □ Yes □ No
3. Submission of test report / □ Yes □ No

４．Factory

Address
Factory name
ISO900xcertificate / □ Yes （Expiration date ） □ No

５．Contact person

Company name
Address
Department
Name
e-mail
Telephone / FAX number

６．Address for invoice □ Same as above

Company name
Address
Department
Name
e-mail
Telephone / FAX number

７． Certification label □ provided by applicant

(Form2-5)

Summary of application equipment

1. Usage explanation
2. Specifications
Item / Specifications
(1) / Classification of specified radio equipment
(2) / Power source
(3) / Frequency
(4) / Modulation method
(5) / Rated output power
(6) / Occupied band width
(7) / Antenna
(8) / Interface
(9) / Construction
(10) / Attachments
(11) / Remarks
3. Composition
Item / Quantity / Remarks
4. Dimension and weight
Item / Height
(mm) / Width
(mm) / Depth
(mm) / Weight
(g)

(Form2-6)

Design Specifications
1.Communication system
2. Transmitter
(1)
Ratedoutput power
(2) Type emission and frequency range
(3) Oscillation
(4) Modulation
3. Manufacturer / Manufacturer / Name or model type / Serial number
4. Antenna / (1) Model and configuration / (2) Gain
5. Classification and model type or name of attachment
6. Other specifications
7. Attached document
8. Remarks

Signature

(Form2-8)

Simplified Application for Type Certification

Date

To: Japan Radio Law Certification Laboratory Co., Ltd.

Applicant / Address
Name of Representative
Company name
Name of Manager-in-charge
Department / Signature

I hereby apply for Type Certification with simplified procedure and submit the attached documents.

Regarding the contents of the application documents, I, as the applicant, will be thoroughly responsible.

Classification of specified radio equipment
Model name
Name of Manufacturer
Type of emission, frequency, and antenna power desired for certification
Radio equipment to be modified / Model name:
Certificate number:
Certificate date:
Changed items / Refer to the attachment
Remarks / □Same number certification application

Details of Changes/Differences

Details of differences / Remarks
Changed Items / Old / New / Electrical
Characteristics