Supplier Declaration of Conformity Form




SCHEDULE E

Supplier Declaration of Conformity

(for Levels of Conformity 1, 2 and 3)

Section 134 of the Radiocommunications Act 1989

Ministry of Economic Development Logo

Radio Spectrum

THIS COMPLETED FORM REMAINS WITH THE SUPPLIER AS PART OF THE DOCUMENTATION REQUIRED FOR THE “COMPLIANCE FOLDER”
DO NOT SUBMIT THIS FORM TO THE MINISTRY.


Supplier’s Details

Name (of New Zealand manufacturer, importer or agent) Address (Street, Suburb, City)
Trading Name (if different) Postcode
New Zealand Company Number (if applicable) Contact Information
Telephone
Postal Address Fax
E-mail

Product Details

Brand Name
Type and Model
Description and Function
Applicable Standard

Supplier Identification (as affixed to product)

  • Supplier Code Number (SCN); or
  • Registered Name and Address; or
  • Registered Company Number; or
  • Registered GST Number; or
  • Registered Trademark; or

Declaration

I declare that the product complies with the standard specified, and that all products to be supplied under this Declaration will be identical to that product.

Signature of Authorised Person Date
Position in Organisation (if Applicable) Print Name


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Online Sources for this page:

VUW Te Waharoa PDF NZ Gazette 2001, No 139


Gazette.govt.nz PDF NZ Gazette 2001, No 139





✨ LLM interpretation of page content

🚂 Supplier Declaration of Conformity Form for Radio Spectrum

🚂 Transport & Communications
Radio Spectrum, Supplier Declaration, Conformity, Radiocommunications Act 1989