RF_160, Issue 04 GadgeTek Inc. 7F.-5,NO.369,FUXING N.RD.,SONGSHAN DIST., Taipei City. Taiwan . Declaration of Authorization We Name:
Address:
City:
Country:
Declare that:
Name Representative of agent:
Agent Company name:
Address:
City:
Country is authorized to apply for Certification of the following product(s):
Product description: Wireless Charging Jim Chang (1) SGS Taiwan Ltd. 134, Wu Kung Rd., Wuku Industrial Zone Wuku Area New Taipei City Taiwan Type designation:
GWD901C Trademark:
GTI Validity/ expiry date August 12, 2020 Taipei City August 12, 2019 on our behalf. Date:
City:
Name:
Function:
Signature:
Notes:
(1): Required for FCC application
(2): For FCC it must be the Grantee Code owner or the authorized agent. Natasha Tai Engineer