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SGS North America Inc. 620 Old Peachtree Road SUITE 100 Suwanee, United States Georgia 30024 Applicant Declaration Applicant Legal Business Name Lorex Technology Inc. Address Grantee Code FCCID 250 Royal crest Court, Markham, L3R 3S1, Ontario, ucz UCZ-AK41 TK-Z Canada. Authorized Contact Name Niles Kanapathipillai Contact Email niles@lorexcorp.com Contact Phone
(905)946-8589 Ext: 125 I, the undesigned,certify that I 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 corectto 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 1n this application, the Applicant isesponsible for
(1) labeling
(2)compliance
(3)compliance the equipment statement of the equipment FCC ID as specified in this application, rules, pusuantto the applicable technical ules, with the exact labeling with the applicable c) if the Applicant manufacturer of the equipment, appropriate arrangements have been made with the manufacturer to ensure that poduction is not the actual units of this equipment will continue to comply with the FCC's technical equirements. 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 ageeto abide by theiresponsibilities as specified unde47CFR 2.909 and KDB394321 e) in accodancewith 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
(2)the Applicant
(3)the Applicant understands, shall make provisions shall, upon request accepts and agrees that a sample may be requested to always have a production sample available by SGS, at the f:pplicant's expense, for surveillance testing provide devices, upon request a production cables, sample of the requested o softwae,accessories by SGS, FCC and/or ISED product or other hardware to SGS, FCC and/or ISED as instructed. software for evaluation, The sample shall include review, all support audit surveillance certification and required of products certified by SGS f) neither the Applicant 5301 of the Anti-Drug 47CFR 1.2002(b nor any party to the application Abuse Act of 1988, 21 U.S.C. 862 because is subject
) for the definition of a "party"
for these purposes to a denial of Federal benefits, that includes FCC benefits, pusuantto Section of a conviction for possession or distribution of a contoiledsubstance. See g) the Applicant has read, undestood,accepts and agrees to abide by the SGS North America, lnc.(TCB) terms and conditions. Link to CFRs: htt s://www.fcc. Link to KDBs: https://apps.fcc.qov/oetcf/kdb/index.cfm Link to RSP-100:
ov/wireless/bureau-divisions/technolo c.ca/eic/site/smt-
st.nsf/en
/sf01130.html htt s://www.ic. ies-s stems-and-innovation-division/rules-re ulations-title-47 Print Name:
Title: I Director of Quality Assurance
*NOTE: This declaration cannot be signed by an Agent, it shall be signed by an authorized person listed in the FCC database Date:2020-06-02 Applicant Deel a ration Rev:0.0