Appendix B: Manufacturer: Applicant Company Number: Hardware Version Identification Number UPN Number: (HVIN): Test Laboratory Name and Equipment Description: Address: Test Laboratory Contact, Antenna Type & Gain: Phone, Fax and Email: All Used IC OATS Test Lab Company Number: Registration Numbers: Emissions Information Radio Field Transmitter Frequency Range RF Power Bandwidth Standard Strength Emission Spurious RSS Issue Minimum Maximum Minimum Maximum Units at Measured Calculated Classification Units at No. No. (MHz) (MHz) (W) (W) Distance (kHz) (kHz) Distance Agreement Signature DECLARATION OF COMPLIANCE: I declare that the testing was performed or supervised by me; that the test measurements were made in accordance with the above-mentioned Industry Canada standard(s); and that the equipment identified in this application has been subjected to all the applicable test conditions specified in the Industry Canada standards and all of the requirements of the standard have been met. Applicant Name: Applicant Title: Applicant Signature: Signature Date: Annex A RF Technical Brief Cover Sheet – All Fields must be completed with the requested information or the following codes: N/A for Not Applicable, N/P for Not Performed or N/V for Not Available. Where applicable, check appropriate box. Company Number: Hardware Version Identification Number (HVIN): Manufacturer:
Appendix B: Manufacturer: Applicant Company Number: Hardware Version Identification Number (HVIN): UPN Number: Test Laboratory Name and Address: Equipment Description: Test Laboratory Contact, Phone, Fax and Email: Antenna Type & Gain: All Used IC OATS Registration Numbers: Test Lab Company Number: Emissions Information Radio Standard Frequency Range RF Power Field Strength Bandwidth Emission Classification Transmitter Spurious Units at Distance RSS No. Issue No. Minimum (MHz) Maximum (MHz) Minimum (W) Maximum (W) Units at Distance Measured (kHz) Calculated (kHz) Agreement Signature DECLARATION OF COMPLIANCE: I declare that the testing was performed or supervised by me; that the test measurements were made in accordance with the above-mentioned Industry Canada standard(s); and that the equipment identified in this application has been subjected to all the applicable test conditions specified in the Industry Canada standards and all of the requirements of the standard have been met. Applicant Name: Applicant Title: Applicant Signature: Signature Date: Annex A – RF Technical Brief Cover Sheet All Fields must be completed with the requested information or the following codes: N/A for Not Applicable, N/P for Not Performed or N/V for Not Available. Where applicable, check appropriate box. Company Number: Hardware Version Identification Number (HVIN): Manufacturer:
ic_application_r2.1.docx