FCC/TCB Approvals Industry Canada Approvals Notified Body for Europe
APPLICATION FORM – NB OPINION
PRODUCT DESCRIPTION Manufacturer(1) Name : Manufacturer Address :
Brand/Trade Name : Model/Type Designation : Product Description(2) : Product Specifications : Please fill out ANNEX 1
TECHNICAL CONSTRUCTION FILE - APPLICANT INFORMATION Applicant Name (3) : Applicant Address :
Signed by (Name & Title) :
Date : TCF Identification(4) :
CUSTOMER INFORMATION Company Name(5) : Company Address :
Phone number : Contact person(5) : Email address :
(1) The manufacturer is the person responsible for designing and manufacturing a product, and whose intention is to place it on the European Union market. A manufacturer may contract out the design or production. Notes: Companies that have been contracted out by manufacturer shall not be listed. In all cases, the manufacturer is ultimately responsible for the product and its compliance with the law. The manufacturer is also responsible for designing and manufacturing the product in accordance with the essential requirements of all relevant directives, and for following the conformity assessment procedures from the appropriate directives, such as compiling a Technical File, affixing the CE marking, and drawing up the Declaration of Conformity. A manufacturer may be located inside or outside the EU. A manufacturer can appoint an Authorized Representative to act on his/her behalf, but he/she must be located in the EU. (2) Please, describe in no more than 8 words (e.g. 40MHz Remote control for toy, Handheld transceiver, Mobile phone, Portable wireless radio microphones, PDA with GSM and Bluetooth, RFID Reader, etc.). (3) Applicant: Name, address etc of the party seeking the opinion. (4) TCF Identification: Unique identification of the documentation. (5) Company submitting this application to TIMCO. Invoice and Opinion will be sent to contact person.
849 NW State Road 45 • P.O. Box 370 • Newberry, Florida 32669 USA Telephone (352) 472-5500 • (888) 472-2424 • FAX (352) 472-2030 • email: [email protected]
Page 1 of 3 FCC/TCB Approvals Industry Canada Approvals Notified Body for Europe
ANNEX 1 PRODUCT SPECIFICATIONS Intended Use / Category(6) : Non-Specific Short Range Device RF output power : xx dBm or W indicate whether EIRP/ERP/Conducted Frequency band (MHz) : xxx Modulation : AM Antenna type : Integral /or indicate type and gain for detachable antenna Duty cycle (%) : xx
Intended Use/Category(6) : SRD – Wideband data transmission system (Bluetooth) RF output power : xx dBm or W indicate whether EIRP/ERP/Conducted Frequency band (MHz) : 2402-2480 Modulation : FHSS (GFSK) Antenna type : Integral /or indicate type and gain for detachable antenna Duty cycle (%) : xx
Intended Use/Category(6) : SRD – Wideband data transmission system RF output power : 11b: xxmW and 11g: xxmW indicate whether Conducted/or EIRP Frequency band (MHz) : 2412-2472 Modulation : DSSS (BPSK/QPSK/CCK) and OFDM (BPSK/QPSK/16QAM/64QAM) Antenna type : Integral /or indicate type and gain for detachable antenna Duty cycle (%) : 11b: xx and 11g: xx
Intended Use/Category(6) : EGSM900 RF output power : xx dBm or W indicate whether EIRP/ERP/Conducted Frequency band (MHz) : 880-915 Modulation : GMSK Antenna type : Integral /or indicate type and gain for detachable antenna Duty cycle (%) : -
Intended Use/Category(6) : DCS1800 RF output power : xx dBm or W indicate whether EIRP/ERP/Conducted Frequency band (MHz) : 1710-1785 Modulation : GMSK Antenna type : Integral /or indicate type and gain for detachable antenna Duty cycle (%) : -
Intended Use/Category(6) : WCDMA (UMTS) RF output power : xx dBm or W indicate whether EIRP/ERP/Conducted Frequency band (MHz) : 1920-1980 Modulation : QPSK Antenna type : Integral /or indicate type and gain for detachable antenna Duty cycle (%) : -
(6) Please refer to ERC RECOMMENDATION 70-03 or actual standard title for relevant category or intended use.
849 NW State Road 45 • P.O. Box 370 • Newberry, Florida 32669 USA Telephone (352) 472-5500 • (888) 472-2424 • FAX (352) 472-2030 • email: [email protected]
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ANNEX 2 Technical File in accordance with R&TTE Directive Annex IV
Under the provisions of Annex IV of the Directive 1999/5/EC of the European Parliament and of the Council of 9 March 1999 on Radio Equipment and Telecommunications Terminal Equipment (R&TTE directive) and the mutual recognition of their conformity, We, the undersigned, have established a Technical Construction File as referenced in this application to be presented to the Notified Body to enable assessment of the product conformity with the essential requirements of the R&TTE Directive and to be kept available to the relevant national authorities of any Member State for inspection purposes for a period ending at least 10 years after the last product has been manufactured.
ITEM # TECHNICAL DOCUMENT DESCRIPTION 01 Technical File in accordance with R&TTE directive Annex II point 4 02 Declaration of Conformity in accordance with R&TTE Directive Annex II point 1 and to specific test suites described in R&TTEdirective Annex III
We, the undersigned, have established a Technical file comprising of the following exhibits:
1. (list of exhibits) 2. … 3. … 4. … 5. … 6. … 7.
Drawn up in (type in location) Date (mm/dd/yyyy) Signature
Family/Last Name and First/Given Name Position/Title Company Name(7) (Applicant)
(7) Applicant or authorized agent. If the agent signed here (for example test labs), please provide an authorization letter from the applicant.
849 NW State Road 45 • P.O. Box 370 • Newberry, Florida 32669 USA Telephone (352) 472-5500 • (888) 472-2424 • FAX (352) 472-2030 • email: [email protected]
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