Lantronix EMG 8500 - Edge Management Gateway AUS Supplier s Declaration of Con - Page 1

BCPL SDoC_2476-01 Supplier's declaration of conformity As required by the following Notices:  Radiocommunications (Compliance Labelling - Devices) Notice 2014 made under section 182 of the Radiocommunications Act 1992;  Radiocommunications Labelling (Electromagnetic Compatibility) Notice 2017 made under section 182 of the Radiocommunications Act 1992;  Radiocommunications (Compliance Labelling - Electromagnetic Radiation) Notice 2014 made under section 182 of the Radiocommunications Act 1992; and  Telecommunications (Labelling Notice for Customer Equipment and Customer Cabling) Instrument 2015 made under section 407 of the Telecommunications Act 1997. Instructions for completion Do not return this form to the ACMA. This completed form must be retained by the supplier as part of the documentation required for the compliance records and must be made available for inspection by the ACMA when requested. Supplier's details Company Name (OR INDIVIDUAL) RCM Responsible Supplier number Braco Compliance Pty Ltd E304 Street Address (Australian) Unit 308, 469-481 High St Northcote, VIC 3070 OR ACN/ARBN 84156023504 Product details Product description - brand name, type, current model, lot, batch or serial number (if available), software/firmware version (if applicable) Edge Management Gateway, Model EMG8500 (including LTE/4G and Wi-Fi Connectivity Modules). 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 (Electromagnetic Compatibility) Standard 2017, refer UL Verification Services Inc. AS/NZS CISPR 32:2015 test report No. 13009268-E7V1 dated 9 December 2019. Radiocommunications (Short Range Devices) Standard 2014, refer UL Verification Services Inc. test report Nos. 13009263-E5V1 and 13009268-E6V1, both dated 9 December 2019. Telecommunications (Mobile Equipment Air Interface) Technical Standard 2018, refer UL Verification Services Inc. test report No. 13009268-E4V1 dated 9 December 2019 and Sierra Wireless EM7430 ACMA declaration dated 22 July 2016. Telecommunications (Customer Equipment Safety) Technical Standard 2018, refer CB Test Certificate US-34732-UL. Radiocommunications (Electromagnetic Radiation - Human Exposure) Standard 2014. 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 Bruce Maule Director 13 December 2019 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 [email protected] ACMA form - C02 Page 1 of 1 January 2018