EMV CPA Application Card Product Request for Approval

Date: [Insert Date]

EMVCo Card Type Approval Secretariat Email: [email protected]

Note: EMVCo Card Type Approval Secretariat contact may change from time to time. Changes (if any) to this information will be posted on EMVCo website.

RE: Request for Approval – EMV CPA Application Card Product

Product Provider Name: [insert company name] [insert company name] Product Provider Registration: [insert EMVCo registration number] [insert company registration number] Card Product Name: [insert card product name with a unique identifier [insert product Name] (as provided in ICS)] Should this product be listed on the List of Yes No Approved Products on the EMVCo website? Implementation Conformance Statement: [insert ICS registration number [insert ICS ID from EMVCo approved ICS] (ABCDXXXX.vX)] Level 1 Evaluation Laboratory(s): [insert name(s) of laboratory(s)] [insert accredited laboratory name] Level 1 Evaluation Test Report(s): [insert name(s) of laboratory(s)][insert reference number(s) of test report(s)] Chip Provider Electrical Test Procedures [insert name of auditor] Auditor (if applicable): Chip Provider Electrical Test Procedures [insert reference number of audit report] Audit Report (if applicable): Level 2 Evaluation Laboratory: [insert name of laboratory] Level 2 Evaluation Test Report: [insert reference number of test report] [insert test report number]

EMVCo Card Type Approval: Request for Approval for CPA Page 1 of 3 October 2010 1 I respectfully request an approval for the referenced card product. All documentation required for evaluation by EMVCo, as described in the “EMVCo Card Type Approval Administrative Process for CPA,” is referenced above.

[Please select one of the following two sentences:]

I hereby declare that the referenced card product currently conforms to the EMV specification and the CPA specification described in the referenced Implementation Conformance Statement without exception.

[OR]

I hereby declare that the referenced card product currently conforms to the EMV specification and the CPA specification described in the referenced Implementation Conformance Statement with the exception of those items specifically identified in the attached documentation, which includes an impact analysis of the non conformance.

I understand that EMVCo will not issue a Letter of Approval until all reports have been received and accepted including the Card Security Evaluation.

Sincerely,

[Insert Name] [Insert Title] [Insert Company Name]

EMVCo Card Type Approval: Request for Approval for CPA Page 3 of 3 October 2010