SGS North America Inc. Applicant Declaration 620 Old Peachtree Road SUITE 100 Suwanee, Georgia 30024 United States Applicant Legal Business Name Chicony Electronics Co Ltd Address . No.69, Sec, 2, Guangfu Rd., Sanchong Dist. New Taipei City Taiwan 241 Grantee Code E8H FCC {D E8HASA]110 Authorized Contact Name T. S. Chen Contact Email t.s._chen@chicony.com Contact Phone +886 2-6626-6788
|, the undersigned, certify that | am an authorized signatory for the Applicant and therefore declare;
a) in accordance with 47CFR2.911(d), all of the statements herein and the exhibits attached hereto are true and correct to the best of my knowledge and belief. b) in accepting a Grant of Equipment Authorization issued by a TCB, under the authority of the FCC, as a result of the representations made in this application, the Applicant is responsible for:
(1) labeling the equipment with the exact FCC ID as specified in this application,
(2) compliance statement labeling pursuant to the applicable rules,
(3) compliance of the equipment with the applicable technical rules,
) if the Applicant is not the actual manufacturer of the equipment, appropriate arrangements have been made with the manufacturer to ensure that production units of this equipment will continue to comply with the FCCs technical requirements. d) in accordance with 47 CFR 2.909 and KDB394321, the Applicant has read, understood and agrees to accept that they are the responsible party and agree to abide by their responsibilities as specified under 47 CFR 2.909 and KDB394321. e) in accordance with 1S017065, FCC KDB641163, FCC KDB610077, KDB394321 and RSP-100, the Applicant has read, understood, accepts and agrees to abide by the post market surveillance requirements.
(1) the Applicant understands, accepts and agrees that a sample may be requested for surveillance testing.
(2) the Applicant shalf make provisions to always have a production sample available upon request by SGS, FCC and/or ISED.
(3) the Applicant shalf, upon request by SGS, at the Applicant's expense, provide a production sample of the requested product to SGS, FCC and/or ISED as instructed, The sample shall include all support devices, cables, software, accessories or other hardware or software required for evaluation, review, certification and audit surveillance of products certified by SGS. f) neither the Applicant nor any party to the application is subject to a denial of Federal benefits, that includes FCC benefits, pursuant fo Section ]
5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. 862 because of a conviction for possession or distribution of a controlled substance. See ]
47CFR 1.2002(b) for the definition of a party for these purposes. g) the Applicant has read, understood, accepts and agrees to abide by the SGS North America, Inc.(TCB) terms and conditions. Link to CFRs: https:/Awww.fec.gov/wireless/bureau-divisionsfechnologies-systems-and-innovation-division/rules-requlations-title-47 Link to KDBs: https://apps.fec.gov/oetcf/kdb/index.cfm Link to RSP-100: httos:/Ayww.ic.gc.ca/eic/site/smt-gst.nsf/eng/sf01130.him!
Applicant Signature: ; - Date: June 29, 2021 wo ae L> LL Print Name: ES. Chen Title: Manager
*NOTE: This declaration cannot be signed by an Agent, it shall be signed by an authorized person listed in the FCC database Applicant Declaration Rev:0.0