ACMA Declaration of Conformity

Complianceapplicablestandardsandothersupportingdocuments
Evidenceofcompliancewithapplicablestandardsmaybedemonstratedbytestreports,endorsed/accreditedtestreports,
certication/competentbodystatements.
Havinghadregardtothesedocuments,Iamsatisedtheabovementionedproductcomplieswiththerequirementsoftherelevant
ACMAStandardsmadeundertheRadiocommunicationsAct1992andtheT elecommunicationsAct1997.
Listthedetailsofthedocumentstheabovestatementwasmade,includingthestandardtitle,numberand,ifapplicable,numberofthe
testreport/endorsedtestreportorcertication/competentbodystatement
AS/NZSCISPR12
Iherebydeclarethat:
1.
IamauthorisedtomakethisdeclarationonbehalfoftheCompanymentionedabove,
2.
thecontentsofthisformaretrueandcorrect,and
3.theproductmentionedabovecomplieswiththeapplicableabovementionedstandardsandallproductssuppliedunder
thisdeclarationwillbeidenticaltotheproductidentiedabove.
Note:Undersection137.1oftheCriminalCodeAct1995,itisanoffencetoknowinglyprovidefalseormisleadinginformationtoa
Commonwealthentity.
Penalty:12monthsimprisonment
EngineeringDirector
SIGNATUREOFSUPPLIERORAGENTPOSITIONINORGANISATION
JohnHurstMarch23,2021
PRINTNAMEDATE
ThePrivacyAct1988(Cth)(thePrivacyAct)imposesobligationsontheACMAinrelationtothecollection,security,quality,access,use
anddisclosureofpersonalinformation.TheseobligationsaredetailedintheAustralianPrivacyPrinciples.
TheACMAmayonlycollectpersonalinformationifitisreasonablynecessaryfor,ordirectlyrelatedto,oneormoreoftheACMA’s
functionsoractivities.
Thepurposeofcollectingthepersonalinformationinthisformistoensurethesupplierisidentiedinthe‘Declarationofconformity’.If
thisDeclarationofConformityisnotcompletedandtherequestedinformationisnotprovided,acompliancelabelcannotbeapplied.
FurtherinformationonthePrivacyActandtheACMA’sPrivacyPolicyisavailableatwww.acma.gov.au/privacypolicy.ThePrivacyPolicy
containsdetailsabouthowyoumayaccesspersonalinformationaboutyouthatisheldbytheACMA,andseekthecorrectionofsuch
information.ItalsoexplainshowyoumaycomplainaboutabreachofthePrivacyActandhowwewilldealwithsuchacomplaint.
Shouldyouhaveanyquestionsinthisregard,pleasecontacttheACMA’sprivacycontactofcerontelephoneon1800226667
orbyemailatprivacy@acma.gov.au.
ACMAformC02
Page2of2March2021(3445-649B)