SGS North America Inc.
620 Old Peachtree Road
SUITE 100
Suwanee, Georgia 30024
United States
Applicant Declaration
111 Sylvan Avenue,North Building, Englewood Cliffs,New Jersey 07632 United States
Applicant Legal Business Name
LG Electronics USA
Address
Grantee Code
FCC ID
Contact Email
Contact Phone
Authorized Contact Name
BEJ
BEJV174NAA
Sung Soo Kim
sungsoo.kim@lge.com
201-266-2215
a)
b)
c)
d)
e)
I, the undersigned, certify that I am an authorized signatory for the Applicant and therefore declare;
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.
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)
(2)
(3)
labeling the equipment with the exact FCC ID as specified in this application,
compliance statement labeling pursuant to the applicable rules,
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 FCC’s technical requirements.
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.
in accordance with ISO17065, 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)
(2)
(3)
the Applicant understands, accepts and agrees that a sample may be requested for surveillance testing.
the Applicant shall make provisions to always have a production sample available upon request by SGS, FCC and/or ISED.
the Applicant shall, 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 to 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://www.fcc.gov/wireless/bureau-divisions/technologies-systems-and-innovation-division/rules-regulations-title-47
Link to KDBs: https://apps.fcc.gov/oetcf/kdb/index.cfm
Link to RSP-100: https://www.ic.gc.ca/eic/site/smt-gst.nsf/eng/sf01130.html
Applicant Signature:
Date:2021-08-12
Print Name:
Title:
Sung Soo Kim
Director, Regulatory and Environmental Affairs
*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