ApplicationforCertification(ConstructionTypeCertification).docVIP

Application for Certification (Construction Type Certification) for Japan Applicant: Company FULL Name: Applicant is: - Manufacturer - Brand Owner ADDRESS: Name of President or CEO: Name: Title: Location: Phone: Email: Is ISO9001 Available? - Yes - No Person in Charge for the Application: ADDRESS: Name: Title: Location: Phone: Email: Manufacturer/Factory: Company FULL Name: ADDRESS: Name: Title: Location: Phone: Email: Is ISO9001 Available? - Yes - No Note: If more than one factory is involved, provide all factories ISO certificates Agent: Company FULL Name: ADDRESS: Name: Title: Location: Phone: Email: Japan Representative: Company FULL Name: ADDRESS: Name: Title: Location: Phone: Email: Brand Owner / Brand Name (Brand Company Name is Shown in the Certificate and the Certified Label): Company FULL Name: ADDRESS: Name: Title: Location: Phone: Email: Contact Person for Inquiries: Name: Email: Phone: Type of Application / Description of Equipment: Certification Type: : Type Certification Equipment is to be Certified as Radio Equipment Under Article 2, Paragraph , Item of the Certification Ordinance Type, or Name/Model of Radio Equipment: New Certification or a Supplement for Existing Certification - New - Update In Cases of Updated application: Changes in Construction Design - Yes - No Changes in Statement of Verification Method - Yes - No Certification Number Difference from Certified Radio Equipment (Provide attached description) FREQUENCY RANGE (fixed frequency or from - to -): Fundamental Power (as specified by Radio Law) Only 1 Section Need be Used as Appropriate RATED R.F. POWER IN WATTS (RF conducted/ERP/EIRP):