Application Form (Test Certification)

Application for Test Certification of Conformity
with the Technical Regulations

Date of application

To:Telecom Engineering Center

Applicant Address:
Name:
Sealing or signature:

I hereby apply for certification of conformity with the technical regulations the specified radio equipment, which details are described below, in accordance with the provisions of Article 3 of the Ordinance of Technical Regulations Conformity Certification of Specified Radio Equipment.

Descriptions

Classification of specified radio equipment
Model name
Manufacturer name
Serial number
Quantity
Type of emissions, frequency and antenna power to be certified
Remarks

(A4size)

Note for Application Form (Test Certification)

1.	If applicant is a legal entity or organization, enter the location of its head office or main business office.
2.	When application is handwritten by the applicant, seal stamping can be omitted. If the applicant is a legal entity or organization, its trade name or denomination as well as the title and full name of the representative must be entered.
3.	According to the "Table II-1 Classification of radio equipment for certification", entry must be made using the phrase "Radio equipment falling under Item ( ) of Article 2".
4.	Model name to be entered must be the same as that written in the attached documents and on the equipment label.
5.	No entry is required when candidate equipment is not submitted.
6.	Enter all kinds of types and frequencies of the radio wave and the antenna power for which the application is made. The entry may be made in the form of "F2D between 903.0125 MHz and 904.9875 MHz (25 kHz interval, 80 waves)" for the application of many wave types and/or frequencies, and in frequency bands for an amateur station. If the equipment applied has the antenna power control function, enter the maximum power.
7.	The following entries are required; (1) Describe that the documents required are attached. (2) Describe name of person to be contacted, his position, company name, address, and phone and fax numbers. (3) Describe the possibility of connection to telecommunication circuit in the form of "Connection to telecommunication circuit: Yes (or No)".