✨ Supplier's Declaration of Conformity
NEW ZEALAND GAZETTE
No. 39
SCHEDULE
Supplier’s Declaration of Conformity
Section 134(1)(g) Radiocommunications Act 1989
THIS COMPLETED FORM REMAINS WITH THE SUPPLIER AS PART OF THE DOCUMENTATION REQUIRED FOR THE “COMPLIANCE FOLDER”
Supplier’s Details
Name (of manufacturer or importer)
Address (of manufacturer or importer)
NZ Company Number
Postcode
GST Number
Contact Information
Telephone
Fax
Postal Address (if different)
Supplier Code Number
Z
Product Details
Brand Name
Model, lot, batch or serial number (as applicable)
Description and Function
Standard title, number and edition
Test Report Number
Declaration
I hereby declare that the product mentioned above complies with the above mentioned standard specified, and all products supplied under this Declaration will be identical to the sample identified above.
Signature of supplier / agent Date
Position in Organisation
Print Name
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Online Sources for this page:
VUW Te Waharoa —
NZ Gazette 2003, No 39
Gazette.govt.nz —
NZ Gazette 2003, No 39
✨ LLM interpretation of page content
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Supplier’s Declaration of Conformity
(continued from previous page)
🏭 Trade, Customs & IndustryDeclaration, Conformity, Radiocommunications, Compliance