FCC ID: A3LCBAQ210A RF MODULE

1. Functional Description CBAQ210A is the module for BLE at embedded and Digital appliance applications. It is based on Airoha AB1611 solution which comprises single chip with integrated BLE 5.0 2. Features BLE - compliant Supports Adaptive Frequency Hopping On chip support for serial peripheral interface (master and slave modes) Dimension : 22 mm x 10 mm / H max: 3.5 mm Interface : UART Interface RoHS compliant Supply Voltage : VCC 3.3V (1.9V~3.6V) Power Consumption : 100mW 3. Application Handheld BLE appliance 5. Electrical Characteristics 1) Absolute Maximum Ratings VDD_3V3(VBAT) DC supply voltage 2) Power Consumption Symbol Parameter Min. Max. 3.6V Unit V Parameter Conditions Min. Nom. Max. Unit TX Power 27.9 mA Tx current @9.5dBm 6. RF Specifications 1) Transmitter Item Maximum RF transmit power Peak power Average power In-band emissions +3MHz Modulation f1avg characteristics Percent of 225 99.9

+2MHz

-2MHz

-3MHz f2max >

185kHz Min. Max. Typ. 8.5 Unit dBm dB dBm dBm dBm dBm kHz

3

-30

-20

-20

-30 275 100 f2avg/f1avg 1 Center freq. deviation, Fn (n =

-150

+150 kHz 0,1,2,.k) Freq. drift, |F0 - Fn| (n = 2,3,4,k) Initial freq. drift, |F1 - F0|

Max. freq. drift rate, |Fn - Fn-5| (n =

-50

-20

-20 6,7,8,k) Harmonics (cable mode)

+50

+20

+20 kHz kHz KHz/50us

-45 dBm Typ.

-90 Max. Min.

-10 21 15 15

-17

-15

-27

-9 Unit dBm dBm dB dB dB dB dB dB dB dBm dBm dBm dBm dBm kHz 50 2) Receiver Item Sensitivity Maximum input level Co-Channel interference, C/I Adjacent channel interference, C/I F = F0+1MHz F = F0-1MHz F = F0+2MHz F = F0-2MHz F = F0+3MHz F = F0-3MHz Intermodulation Blocking 30-2000 MHz

-50

-30

-35

-35 2003-2399 MHz 2484-2997 MHz 3000-12750 MHz -30 PER report integrity 7. Manufacturing Site PT. SAMJIN Bekasi International Industrial Estate, JI. Inti Raya Block C2 No. 10. Desa Sukaresmi, Kec. Cikarang Selatan, Bekasi 17550 - INDONESIA TEL : +62-21-897-2585 FAX : +62-21-8990-6983 Qingdao SAMJIN ELECTRONIC CO.,LTD No.27, Tongkang-road, Tonghe-town PINGDU CITY, QINGDAO, SHANDONG, CHINA TEL: +86-532-8731-1222 FAX: +86-532-8731-1215 1) FCC Compliance Statement This device complies with part 15 of the FCC rules. Operation is subject to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation. 2) FCC Interference Statement This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to correct the interference by one of the following measures:

Reorient or relocate the receiving antenna. Increase the separation between the equipment and receiver. Connect the equipment into an outlet on a circuit different from which the receiver is connected. Consult the dealer or an experienced radio/TV technician for help. 3) FCC Caution Any changes or modifications not expressly approved by the party responsible for compliance could void the user's authority to operate this equipment. This transmitter must not be co-located or operating in conjunction with any other antenna or transmitter. 4) FCC Radiation Exposure Statement :

This equipment complies with FCC radiation exposure limits set forth for an uncontrolled environment. This equipment should be installed and operated with minimum distance 20 cm between the radiator and your body. This transmitter must not be co-located or operating in conjunction with any other antenna or transmitter. 1) Industry Canada Statement This device complies with Industry Canada licence-exempt RSS standard(s). Operation is subject to the following two conditions: (1) this device may not cause interference, and (2) this device must accept any interference, including interference that may cause undesired operation of the device. Le pr sent appareil est conforme aux CNR d'Industrie Canada applicables aux appareils radio exempts de licence. L'exploitation est autoris e aux deux conditions suivantes : (1) l'appareil ne doit pas produire de brouillage, et (2) l'utilisateur de l'appareil doit accepter tout brouillage radio lectrique subi, m me si le brouillage est susceptible d'en compromettre le fonctionnement. 2) Industry Canada Radiation Exposure Statement

(D claration dexposition aux radiations ):

This equipment complies with IC radiation exposure limits set forth for an uncontrolled environment. This equipment should be installed and operated with minimum distance 20 cm between the radiator & your body. Cet quipement est conforme aux limites dexposition aux rayonnements IC tablies pour un environnement non con tr l . Cet quipement doit tre install et utilis avec un minimum de 20 cm de distance entre la source de rayonnement et votre corps. IMPORTANT NOTE:

This module is intended for OEM integrator. The OEM integrator is still responsible for the FCC compliance requirement of the end product, which integrates this module. 20cm minimum distance has to be able to be maintained between the antenna and the users for the host this module is integrated into. Under such configuration, the FCC radiation exposure limits set forth for an population/uncontrolled environment can be satisfied. Any changes or modifications not expressly approved by the manufacturer could void the user's authority to operate this equipment. The OEM integrator is responsible for the compliance to all the rules that apply to the product in to which this certified RF module is integrated. This module must be integrated into a device where the user cannot access the antenna connector and should not be able to remove or install the module. USERS MANUAL OF THE END PRODUCT:

In the users manual of the end product, the end user has to be informed to keep at least 20cm separation with the antenna while this end product is installed and operated. The end user has to be informed that the FCC radio-frequency exposure guidelines for an uncontrolled environment can be satisfied. The end user has to also be informed that any changes or modifications not expressly approved by the manufacturer could void the user's authority to operate this equipment. If the size of the end product is smaller than 8x10cm, then additional FCC part 15.19 statement is required to be available in the users manual: This device complies with Part 15 of FCC rules. Operation is subject to the following two conditions: (1) this device may not cause harmful interference and (2) this device must accept any interference received, including interference that may cause undesired operation. The final host product still requires Part 15 Subpart B compliance testing with the modular transmitter installed. LABEL OF THE END PRODUCT:

The final end product must be labeled in a visible area with the following " Contains TX FCC ID: A3LCBAQ210A ". If the size of the end product is larger than 8x10cm, then the following FCC part 15.19 statement has to also be available on the label: This device complies with Part 15 of FCC rules. Operation is subject to the following two conditions: (1) this device may not cause harmful interference and (2) this device must accept any interference received, including interference that may cause undesired operation. IC Statement This Class B digital apparatus complies with Canadian ICES-003. Operation is subject to the following two conditions: (1) this device may not cause interference, and (2) this device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil numrique de la classe B est conforme la norme NMB-003 du Canada. This device and its antenna(s) must not be co-located or operation in conjunction with any other antenna or transmitter. The device could automatically discontinue transmission in case of absence of information to transmit, or operational failure. Note that this is not intended to prohibit transmission of control or signaling information or the use of repetitive codes where required by the technology. IMPORTANT NOTE:

This module is intended for OEM integrator. The OEM integrator is still responsible for the IC compliance requirement of the end product, which integrates this module. 20cm minimum distance has to be able to be maintained between the antenna and the users for the host this module is integrated into. Under such configuration, the IC RSS-102 radiation exposure limits set forth for an population/uncontrolled environment can be satisfied. Any changes or modifications not expressly approved by the manufacturer could void the user's authority to operate this equipment. USERS MANUAL OF THE END PRODUCT:

In the users manual of the end product, the end user has to be informed to keep at least 20cm separation with the antenna while this end product is installed and operated. The end user has to be informed that the IC radio-frequency exposure guidelines for an uncontrolled environment can be satisfied. The end user has to also be informed that any changes or modifications not expressly approved by the manufacturer could void the user's authority to operate this equipment. IC statement is required to be available in the users manual: This Class B digital apparatus complies with Canadian ICES-003. Operation is subject to the following two conditions: (1) this device may not cause harmful interference and (2) this device must accept any interference received, including interference that may cause undesired operation. LABEL OF THE END PRODUCT:

The final end product must be labeled in a visible area with the following " Contains TX IC : 649E-CBAQ210A ".

4709- 0028XX

<BLE Module PI Label>

IC: 649E-CBAQ210A FCC ID: A3LCBAQ210A R-R-SEC- CBAQ210A 210JECH0001 XXX 123456789012 Front of the module / Location of label

Samsung Electronics Co., LTD. 129, Samsung -ro , Yeongtong-gu Suwon-City, Gyeonggi-do, 16677, Korea Date: March 19, 2020 Federal Communications Commission 7435 Oakland Mills Road Columbia MD 21046 c.c. UL Verification Services Certification Division 47173 Benicia Street Fremont, CA 94538, USA To whom it may concern:

I, the undersigned, hereby authorize Ms. Athena Kim/Assistant manager of KCTL Inc. and hereafter referred to as KCTL to act on our behalf in all manners relating to application for equipment authorization, including signing of all documents relating to these matters. Any and all acts carried out by Ms. Athena Kim/Assistant manager of KCTL Inc. on our behalf shall have the same effect as acts of our own. I, the undersigned, hereby certify that we are not 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. 853(a). In authorizing KCTL as our agent, we still recognize that we are responsible to:

a) b) c) d) comply with the relevant provisions of the certification program;

make all necessary arrangements for the conduct of the evaluation, including provision for examining documentation and access to all areas, records (including internal audit reports) and personnel for the purposes of evaluation (e.g. testing, inspection, assessment, surveillance, reassessment) and resolution of complaints;

make claims regarding certification only in respect of the scope for which certification has been granted;

do not use our product certification in such a manner as to bring the Certification Division into disrepute and not make any statement regarding our product certification which the Certification Division may consider misleading or unauthorized;

e) f) g) h) i) j) upon suspension or cancellation of certification, discontinue use of all advertising matter that contains any reference thereto and return any certification documents as required by the Certification Division;

use certification only to indicate the products are certified as being in conformity with specified standards;

endeavor to ensure that no certificate or report nor any part thereof is used in a misleading manner;

ensure that any reference to our product certification in communication media such as documents, brochures or advertising, complies with the requirements of the Certification Division;

keep a record of all complaints made known to the us relating to the products compliance with requirements of the relevant standard and to make these records available to the Certification Division when requested;

take appropriate action with respect to such complaints and any deficiencies found in products or services that affect compliance with the requirements for certification;

k) document the actions taken. This authorization is valid until further written notice from the applicant. Sincerely Yours, Jenni Chun/ General manager

Samsung Electronics Co., LTD. 129, Samsung -ro , Yeongtong-gu Suwon-City, Gyeonggi-do, 16677, Korea CONFIDENTIALITY REQUEST Federal Communication Commission Equipment Authorization Division, Application Processing Branch 7435 Oakland Mills Road Columbia, MD 21048 March 19, 2020 TO WHOM IT MAY CONCERN Pursuant to Paragraphs 0.457 and 0.459 of the Commissions Rules (47 C.F.R.) and Section 552(b)(4) of the Freedom of Information Act, Samsung Electronics Co., Ltd. requests confidentiality for the following products:

FCC ID Number Product Title/Model A3LCBAQ210A RF MODULE / CBAQ210A The following exhibits contain trade secrets and proprietary information that could be of benefit to our competitors regarding the design of our product. This material is not customarily available to the general public and we request that it be withheld from public inspection. We request that the following information submitted be held permanent confidential treatment. Permanent Confidential Request

-. Schematics

-. Block Diagram

-. Operational Description

-. Antenna specification

-. External Photos

-. Internal Photos

-. Test set-up photo

-. User Manual We also hereby request Short-Term Confidentiality for 180 days after the grant as outlined in Public Notice DA 04-1705. This provision will give temporary confidentiality of commercially sensitive information prior to product release. Short-Term Confidential Request If you have any questions, please feel free to contact me at the address shown below. Sincerely, Jenni Chun/ General manager

Applicant/Grantee FCC ID:

Samsung Electronics Co., Ltd. A3LCBAQ210A Request for Modular Approval Request for Limited Modular Approval Section 15.212 Modular Transmitters Requirements EUT Conditions Single Modular Approval Requirements Comply (Y/N) A DC-DC converter is configured for internal supply of the module. Connected to antenna with internal transmission line and matching. Y Y Y Y Y 1 2 3 4 5 OK OK OK The radio elements of the modular transmitter must have their own shielding. The physical crystal and tuning capacitors may be located external to the shielded radio elements. The modular transmitter must have buffered modulation/data inputs (if such inputs are provided) to ensure that the module will comply with Part 15 requirements under conditions of excessive data rates or over-

modulation. The modular transmitter must have its own power supply regulation. The modular transmitter must comply with the antenna and transmission system requirements of Sections 15.203, 15.204(b) and 15.204(c). The antenna must either be permanently attached or employ a unique antenna coupler (at all connections between the module and the antenna, including the cable). The professional installation provision of Section 15.203 is not applicable to modules but can apply to limited modular approvals under paragraph

(b) of this section. The modular transmitter must be tested in a stand-alone configuration, i.e., the module must not be inside another device during testing for compliance with Part 15 requirements. Unless the transmitter module will be battery powered, it must comply with the AC line conducted requirements found in Section 15.207. AC or DC power lines and data input/output lines connected to the module must not 6 Mark the FCC-ID certification number Y on the module label. contain ferrites, unless they will be marketed with the module (see Section 15.27(a)). The length of these lines shall be the length typical of actual use or, if that length is unknown, at least 10 centimeters to insure that there is no coupling between the case of the module and supporting equipment. Any accessories, peripherals, or support equipment connected to the module during testing shall be unmodified and commercially available (see Section 15.31(i)). The modular transmitter must be equipped with either a permanently affixed label or must be capable of electronically displaying its FCC identification number.

(A) If using a permanently affixed label, the modular transmitter must be labeled with its own FCC identification number, and, if the FCC identification number is not visible when the module is installed inside another device, then the outside of the device into which the module is installed must also display a label referring to the enclosed module. This exterior label can use wording such as the following: Contains Transmitter Module FCC ID: XYZMODEL1 or Contains FCC ID: XYZMODEL1. Any similar wording that expresses the same meaning may be used. The Grantee may either provide such a label, an example of which must be included in the application for equipment authorization, or, must provide adequate instructions along with the module which explain this requirement. In the latter case, a copy of these instructions must be included in the application for equipment authorization.

(B) If the modular transmitter uses an electronic display of the FCC identification number, the information must be readily accessible and visible on the modular transmitter or on the device in which it is installed. If the module is installed inside another device, then the outside of the device into which the module is installed must display a label referring to the enclosed module. This exterior label can use wording such as the following:

Contains FCC certified transmitter module(s). Any similar wording that expresses the same meaning may be used. The user manual must include instructions on how to access the electronic display. A copy of these instructions must be included in the Module usage manuals were provided. Y 7 8 application for equipment authorization. The modular transmitter must comply with any specific rules or operating requirements that ordinarily apply to a complete transmitter and the manufacturer must provide adequate instructions along with the module to explain any such requirements. A copy of these instructions must be included in the application for equipment authorization. The modular transmitter must comply with any applicable RF exposure requirements in its final configuration. For RF exposure requests, ensure that RF specs are entered and adhered to within the approval source provided to all users fo this module. Y A limited modular approval may be granted for single or split modular transmitters that do not comply with all of the above requirements, e.g., shielding, minimum signaling amplitude, buffered modulation/data inputs, or power supply regulation, if the manufacturer can demonstrate by alternative means in the application for equipment authorization that the modular transmitter meets all the applicable Part 15 requirements under the operating conditions in which the transmitter will be used. Limited modular approval also may be granted in those instances where compliance with RF exposure rules is demonstrated only for particular product configurations. The applicant for certification must state how control of the end product into which the module will be installed will be maintained such that full compliance of the end product is always ensured.