Telecom | Certification Body Australia (CBA)

APPLICATION FOR THE ISSUE OF ACMA CB STATEMENT AND TELECOM CERTIFICATION / MODIFICATION

Electrical Product Safety Certification Scheme (EPSCS)nSection 376 Section Technical standards & 407 Section Labelling Requirements of Telecommunication Act 1997nPlease complete and confirm details below to appear in the ACMA CB Statement and the CBA Telecom Certificate of Compliancen

Electrical Product Safety Certification Scheme (EPSCS)

Section 376 Section Technical standards & 407 Section Labelling Requirements of Telecommunication Act 1997

Please complete and confirm details below to appear in the ACMA CB Statement and the CBA Telecom Certificate of Compliance
Select services required:
- NEW APPLICATION
- MODIFICATION
- RENEWAL
ACMA CB Statement/Certificate of Approval Holder Details:
Registered Company Name:
ABN (if applicable):
Mailing Address:
Contact Person:
Telephone No.:
Email:
Agent Details (if applicable) - please submit Agent’s Authorisation:
Agent Name:
Mailing Address
Contact for Enquiries
Telephone No.
Email
Manufacturer Details:
Manufacturer Name & Address
Factory Name & Address
Product Information:
Product:
Trade Mark:
Model No.:
Software Version:
Hardware Version:
Other marking:
Non-compliance issues:
Do you agree to the Certification Body discussing network integrity issues with carriers or carriage service providers? Tick applicable box.
- Yes
- No
Modification and Renewal Application Details:
Original Certificate Number:
Date of Issue:
Original Model No.:
Indicate changes in the design, material or construction from the original approved product:
- 1. Submission of an application and payment does not require the certification body to issue a certificate that the customer equipment or customer cabling complies with the standards where it does not in the opinion of the certification body.
- 2. The maximum processing time for a complete application is 20 working days subject to carrier clearance (if applicable).
- 3. The applicant may request a stop of work on the application at any time. In this case, the application will be returned but the payment will be retained.
Checklist for documentation required:
Accredited test reports and certificates (to show compliance to AS standard or equivalent)
Max. file size: 128 MB.
Instruction manuals, rating labels, warnings (English language only)
Max. file size: 128 MB.
Colour photographs, certification for critical components
Max. file size: 128 MB.
Agent’s authorisation (if applicable)
Max. file size: 128 MB.
Other
Max. file size: 128 MB.
TEST SAMPLE WILL BE REQUIRED
I hereby declare that:
- (a) The contents of this application and any enclosures are true and correct; and
- (b) I have the authority to sign this application on behalf of the applicant.
- (c) That I did not apply this device for approval with other ACMA Certification Body
Each article described above complies with the standards nominated.

Each article of the description specified above for which approval is hereby sought, is identical to the electrical article being the subject of the test reports attached.

Any modification to components, construction or design of the article will be notified to Certification Body Australia.

I agree and comply with the obligations set out in the CBA Terms and Condition for certification services.
Declaration:
I confirm my declaration above
- YES
- NO
Date
Print Name:
Title:
Certification Fees (excl. GST) – all prices in Australian dollars
New certificate application (Australian telecom approval): Price confirmed on application Certificate Addendum (simple technical change): 600.00
Certificate Renewal: 750.00
Certificate Modification (non-technical change): 350.00

APPLICATION FOR THE ISSUE OF ACMA CB STATEMENT AND TELECOM CERTIFICATION / MODIFICATION

ACMA CB Statement/Certificate of Approval Holder Details:

Agent Details (if applicable) - please submit Agent’s Authorisation:

Manufacturer Details:

Product Information:

Non-compliance issues:

Modification and Renewal Application Details:

Checklist for documentation required:

TEST SAMPLE WILL BE REQUIRED

Declaration:

Certification Fees (excl. GST) – all prices in Australian dollars

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