REPUBLIC OF THE PHILIPPINES

NATIONAL TELECOMMUNICATIONS COMMISSION

BIR Road, East Triangle, Diliman, Quezon City

APPLICATION FOR TYPE-ACCEPTANCE CERTIFICATE

RADIO COMMUNICATION EQUIPMENT

Instruction:
This application form must be filled-up correctly and properly by the applicant supported with complete
documentary requirements. It must be signed by a senior official of the company or its authorized
representative.

1. Applicant (Name of Company): ____Norwegian Pacific Offshore Inc._________________

2. Address: #14 Magellans Landing Compound Argonaut Highway SBFZ, Olongapo City_
3. Telephone No.: _047-252-2689 Website & E-mail: www.,norwegianpacificoffshore.com &norpos.subic@mozcom.com
4. General Description of Equipment
Equipment Category : ____________________Radar Device _________________________
Trade/Brand Name : _____________________SIMRAD_____________________________
Model : _______________________4G _______________________________
Frequency Range : ______________________9300-9400 MHZ_______________________
RF Power Output : ______________________0.2W________________________________
Emission Designation: _______________________________________ _______
Modulation Type : ________________________PON______________________________
Number of Channel : _________________________________________________________
Channel Spacing : _________________________________________________________
Manufacturer : Navico Auckland Limited/ Navico Holdings As/Navico Marine Singapore PTE LTD
Address & Website : 10 Arumugan Road, #03.00 LTC Building A Singapore 409957____

5. Supporting documents:

[/] Letter of Authorization from the Equipment Manufacturer to Local Applicant/Agent.

[/ ] Equipment photo, description/data sheet & RF technical specifications.
[/] Manufacturer’s Declaration of Conformity.
[ /] Certificate & test report issued by a regulatory body or an accredited conformity
assessment body (CAB) showing compliance of the equipment with the following:
[ / ] Electrical Safety i.e. IEC 60950
[ / ] Electromagnetic Compatibility (EMC) i.e.
CISPR22 EN55022 EN50082
EN6100-3-2/3 IEC801-2/3/4 FCC CFR Title 47, Part 15
EN 301 489
[ / ] SAR/Health Safety (for wireless equipment / mobile phone) i.e. -
ICNIRP 1999/519/EC ES 59005
EN 50360/1 ANSI/IEEE C95.1AS/NZS 2772.1
[ / ] Radio Spectrum Efficiency (for wireless equipment) i.e.
EN 301 511 EN 301 908-2 EN 300 220
EN 301 908-1 EN 300 328 EN 302 291

I hereby certify that all the information given in this application form including the supporting
documentary requirements are true and correct. If found that any false information or
misrepresentation made thereto shall be a ground for the denial of this application and/or
cancellation/revocation of the type acceptance certificate that has been issued to us and renders me
liable for criminal prosecution.

_____Rheenzel Mejos
Authorized Signatory
(Signature over Printed Name)

__________Admin Officer_________
Position/Official Capacity

_________norpos.subic@mozcom.com ____
Email Address

.
 REPUBLIC OF THE PHILIPPINES
NATIONAL TELECOMMUNICATIONS COMMISSION
BIR Road, East Triangle, Diliman, Quezon City

APPLICATION FOR TYPE-ACCEPTANCE CERTIFICATE

RADIO COMMUNICATION EQUIPMENT

Instruction:
This application form must be filled-up correctly and properly by the applicant supported with complete
documentary requirements. It must be signed by a senior official of the company or its authorized
representative.

1. Applicant (Name of Company): ____Norwegian Pacific Offshore Inc._________________

2. Address: #14 Magellans Landing Compound Argonaut Highway SBFZ, Olongapo City_
3. Telephone No.: 047-252-2689 Website & E-mail: www.,norwegianpacificoffshore.com &norpos.subic@mozcom.com
4. General Description of Equipment
Equipment Category : ____________________Multifunction Display/ Wifi & BT___________
Trade/Brand Name : _____________________SIMRAD_____________________________
Model : _______________________NSS16 EVO 3______________________
Frequency Range : ______________________ __________________________________
RF Power Output : __________________________________________________________
Emission Designation: _______________________________________ _______
Modulation Type : ___________________________ ______________________________
Number of Channel : __ ___ 34 channels _______________________
Channel Spacing : _________________________________________________________
Manufacturer : Navico Auckland Limited/ Navico Holdings As/Navico Marine Singapore PTE LTD
Address & Website : 10 Arumugan Road, #03.00 LTC Building A Singapore 409957____

6. Supporting documents:

[/] Letter of Authorization from the Equipment Manufacturer to Local Applicant/Agent.

[/ ] Equipment photo, description/data sheet & RF technical specifications.
[/] Manufacturer’s Declaration of Conformity.
[ /] Certificate & test report issued by a regulatory body or an accredited conformity
assessment body (CAB) showing compliance of the equipment with the following:
[ / ] Electrical Safety i.e. IEC 60950
[ / ] Electromagnetic Compatibility (EMC) i.e.
CISPR22 EN55022 EN50082
EN6100-3-2/3 IEC801-2/3/4 FCC CFR Title 47, Part 15
EN 301 489
[ / ] SAR/Health Safety (for wireless equipment / mobile phone) i.e. -
ICNIRP 1999/519/EC ES 59005
EN 50360/1 ANSI/IEEE C95.1AS/NZS 2772.1
[ / ] Radio Spectrum Efficiency (for wireless equipment) i.e.
EN 301 511 EN 301 908-2 EN 300 220
EN 301 908-1 EN 300 328 EN 302 291

I hereby certify that all the information given in this application form including the supporting
documentary requirements are true and correct. If found that any false information or
misrepresentation made thereto shall be a ground for the denial of this application and/or
cancellation/revocation of the type acceptance certificate that has been issued to us and renders me
liable for criminal prosecution.

_____Rheenzel Mejos
Authorized Signatory
(Signature over Printed Name)

__________Admin Officer_________
Position/Official Capacity

_________norpos.subic@mozcom.com ____
Email Address