SECTION 1
(Must be completed in full)
Market Name of Product: .........................................................................................................................
[Max. of 40 characters see note]
Name of Manufacturer:..................................................
Country............................................
Formal Mfr's description/No:.......................................................................................................................
Ringer Number (RN) (Ref PTC 200 § 7.6): ..............................see note
Proposed Telepermit Holder Details: [Must be a New Zealand Company or Resident]
Telepermit Holder:..............................................................................................................................
Street Address:..................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Contact Person :.................................................
Position in Company :..............................................
Telephone:.................................... Fax:........................................
Mailing address [include PO Box number if available]:...........................................................................
.........................................................................................................................................................
.........................................................................................................................................................
In making this application for a reserved number, I undertake not to make any product available for sale until a Telepermit has been formally granted.
Full name of person authorised to sign on behalf of proposed Telepermit Holder: -
.....................................................................................................................
Position in Company:......................................................................................................................
Signed: ...................................................
Date: ..................................................
For Telecom use only
Application Number: CP/AS............./ ...............
Application Received: (date) .........../ .........../ ............
Information Complete: (date) .........../ .........../ ............
Application Acknowledged: (date) .........../ .........../ ............
SECTION 2
Telepermit Applicant Details
(Where different to proposed Telepermit Holder)
Complete this section ONLY if a Company or agent is handling the application on behalf of proposed Telepermit Holder.
(Note that Declaration in Section 1 MUST be signed by the proposed Telepermit Holder)
Applicant: ........................................................................................................................................
Street Address: ...............................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Postal Address: .................................................................................................................................
[include PO Box number if available]
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Contact Person:..................................................Position in Company: ...............................................
Telephone:...................................... Fax:..........................................
Email:................................................
Billing Address (State Telecom Account Number if known): .................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Contact Person:..................................................Position in Company: ...............................................
Telephone:......................................
In all cases, this Application Form when completed should be forwarded directly to:-
| Parcels | |
| Access Standards Telecom New Zealand Level G, Unit 4, Telecom Centre PO Box 570 WELLINGTON 6140 NEW ZEALAND | Access Standards Telecom New Zealand Level G, Unit 4, Telecom Centre 49 - 55 Tory Street WELLINGTON 6011 NEW ZEALAND |
Enquiries:-
| General and Technical enquiries on Telepermit applications etc. should be directed to:- | |||
| Alan Reedy | Tel: +64-4-382 1546 | Fax: +64-4-801 5691 | E-mail: alan.reedy@telecom.co.nz |
| Richard Brent | Tel: +64-4-382 5344 | Fax: +64-4-801 5691 | E-mail: richard.brent@telecom.co.nz |
NOTES
There is no guarantee that a Telepermit will be granted, and product must not
be sold before the appropriate Test Reports have been assessed and a Telepermit
has been formally granted. An artwork is provided to assist with the production of Labels.
2. As labels for all equipment connected to the PSTN (PTC 200)contain the Ringer Number (RN)
for the equipment, this must be provided as part of this application. The RN is found in Test Reports
to PTC 200 clause 7.6.
1. Reserved Telepermit Numbers are issued so that manufacturers can arrange to have
labels printed in parallel with the approval process. It is expected that the
Testing will have already been completed, or at least substantially completed
when a Reserved Number is applied for. Reserved numbers will expire two months after
the date of issue, and be reallocated to other products unless an extension of time is granted.