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© Siemens Switzerland Ltd, CH-6300 Zug
A5W00056028-004
ACMA form – C02
Junly 2021
Compliance – applicable standards and other supporting documents
Evidence of compliance with applicable standards may be demonstrated by test reports, endorsed/accredited test reports,
certification/competent body statements.
Having had regard to these documents, I am satisfied the above mentioned product complies with the requirements of the relevant ACMA
Standards made under the Radiocommunications Act 1992 and the Telecommunications Act 1997.
List the details of the documents the above statement was made, including the standard title, number and, if applicable, number of the test
report/endorsed test report or certification/competent body statement
Radiocommunications Labelling (Electromagnetic Compatibility) Notice 2017
EN 60730-1:2016 +A1:2019
Automatic electrical controls for household and similar use—Part 1: General requirements
ETSI EN 301 489-1 V2.2.3
ElectroMagnetic Compatibility (EMC) standard for radio equipment and services; Part 1: Common technical requirements
ETSI EN 301 489-17 V3.2.2 ETSI EN 301 489-17 V3.2.4
ElectroMagnetic Compatibility (EMC) standard for radio equipment and services; Part 17: Specific conditions for Broadband Data Transmission Systems
Radiocommunications (Compliance Labelling - Devices) Notice 2014
ETSI EN 300 328 V2.1.1 ETSI EN 300 328 V2.2.2
Wideband transmission systems; Data transmission equipment operating in the 2,4 GHz band; Harmonised Standard for access to radio spectrum
Radiocommunications (Compliance Labelling – Electromagnetic Radiation) Notice 2014
EN 62311:2008 EN 62311:2020
Assessment of electronic and electrical equipment related to human exposure restrictions for electromagnetic fields (0 Hz - 300 GHz)
Declaration
I hereby declare that:
1. I am authorised to make this declaration on behalf of the Company mentioned above,
2. the contents of this form are true and correct, and
3. the product mentioned above complies with the applicable above mentioned standards and all products supplied under this declaration will be identical to
the product identified above.
Note: Under section 137.1 of the Criminal Code Act 1995, it is an offence to knowingly provide false or misleading information to a Commonwealth entity.
Penalty: 12 months imprisonment
CH-6300 Zug, 21.07.2021
Signed for and on behalf of:
Siemens Switzerland Ltd
i.V. ………………………………………………
Thomas Nitz
Product Management, Portfolio & Innovation Head
i.V. ……………………………………………..
Rico Jaeggi
Head of R&D Competence Center Zug
The Privacy Act 1988 (Cth) (the Privacy Act) imposes obligations on the ACMA in relation to the collection, security, quality, access, use and
disclosure of personal information. These obligations are detailed in the Australian Privacy Principles.
The ACMA may only collect personal information if it is reasonably necessary for, or directly related to, one or more of the ACMA’s functions or
activities.
The purpose of collecting the personal information in this form is to ensure the supplier is identified in the ‘Declaration of conformity’. If this
Declaration of Conformity is not completed and the requested information is not provided, a compliance label cannot be applied.
Further information on the Privacy Act and the ACMA’s Privacy Policy is available at www.acma.gov.au/privacypolicy. The Privacy Policy
contains details about how you may access personal information about you that is held by the ACMA, and seek the correction of such
information. It also explains how you may complain about a breach of the Privacy Act and how we will deal with such a complaint.
Should you have any questions in this regard, please contact the ACMA’s privacy contact officer on telephone on 1800 226 667 or by email at
[e-mail].
Nitz
Thomas
Digitally signed
by Nitz Thomas
Date: 2021.07.23
15:21:09 +02'00'
Digital signiert von Jaeggi Rico
DN: cn=Jaeggi Rico, o=Siemens,
email=[e-mail]
Grund: Ich stimme dem Dokument
zu
Datum: 2021.07.23 15:23:09 +02'00'
Jaeggi
Rico