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:.......................................................................................................................
Hardware Version No:...............................................
Firmware Version No: ................................................
Year 2000 Compliant: ..........................................................................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:................................... Email:........................................
Mailing address [include PO Box number if available]:...........................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Telepermit Holder or Manufacturers URL:...............................................................................(Optional)see note
In making this application, I undertake to comply with the General
Conditions of Telecom Specification PTC 100 and with any additional
conditions applicable to the grant of a Telecom Telepermit should my
application be successful.
I agree to the disclosure of the product functionality and any warning
notes associated with the conditions of Telepermit grant after the product
has entered service.
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:-
Richard Brent, Alan Reedy or Bill Dawid
| Access Standards Telecom New Zealand Level 3, Gen-i Plaza 57 - 65 Manners Street PO Box 570 WELLINGTON 6011 NEW ZEALAND |
Enquiries:-
| Enquiries on Telepermit applications etc. should be directed to:- | |||
| Alan Reedy | Tel: +64-4-382 1546 | Fax: +64-4-471 1640 | E-mail: alan.reedy@telecom.co.nz |
| Richard Brent | Tel: +64-4-382 5344 | Fax: +64-4-471 1640 | E-mail: richard.brent@telecom.co.nz |
| Bill Dawid | Tel: +64-4-382 5730 | Fax: +64-4-471 1640 | E-mail: bill.dawid@telecom.co.nz |
On receipt of this Application you will be assigned an application Number of the form CPAS YY/SSS, where YY is the last two digits of the year and SSS is a sequence number. Until a Telepermit has been granted, all correspondence with Access Standards MUST quote the Application number, and should be addressed to Anna.
Incomplete applications will NOT BE REGISTERED for processing. They will be placed on 'HOLD' until the application is complete.
SECTION 3
Checklist of Essential Attachments & Supporting Data:-
Place a 'tick' in the following boxes as appropriate for the product concerned, or an 'S' if Test Report supplied previously. Any omissions should be explained fully in a covering letter.
| NETWORK (to be connected to): | |
| PSTN........ | YES / NO |
| ISDN........ | YES / NO |
| Leased Line........ | YES / NO |
| Description of Primary Function(s) with Block Schematic:- ........ | YES / NO |
| List of Additional Facilities of Product:- ........ | YES / NO |
| Test Reports: (see attached Schedule for Report details) | |
| Electrical Safety | |
| - Power Supply:- ........ | YES / NO / S / NA |
| - Line Isolation:- ........ | YES / NO / S |
| Telecommunications Test Report(s) | |
| - PTC/-, TNA/- , etc:- ........ | YES / NO / S / NA |
| - ISDN Layer 1:- ........ | YES / NO / S / NA |
| - ISDN Layer 2:- ........ | YES / NO / S / NA |
| - ISDN Layer 3:- ........ (Must be tested by Telecom New Zealand Ltd) | YES / NO / S / NA |
| - Derived Analogue Port:- ........ (for ISDN analogue TA, PSTN series connected device or leased line multiplex device which derives an analogue port) | YES / NO / S /NA |
| Radio Frequency Allocation Approval from Ministry of Commerce:- ........ (Mandatory requirement for all cordless devices for Telepermit purposes) | YES / NO / S / NA |
| Other Attachments and Supporting Data: | |
| Letters of Authorisation:- ............ (Required if proposed Telepermit Holder does not own Test Reports) | YES / NO / S / NA |
| User Instructions:-........ | YES / NO / S |
| Installation Instructions:- ........ | YES / NO / S / NA |
| Marketing Brochure:- ........ | YES / NO / S |
| Colour Photograph(s) of Equipment:- ........ | YES / NO / S |
| Sample of Equipment (not essential unless called for) :- ........ | YES / NO / S / NA |
................................................................................................................................................................
SECTION 1
1. The Market name of the product will be printed on the
Telepermit Label and must match the name printed on the product
itself and the product documentation. The form of this entry is:
Brand Name, Product Name (i.e. model), Product Class (e.g. facsimile machine,
telephone etc) Note that each individual product name must have a
separate application, Telepermits are not issued to a product family.
2. This Section is required to be completed in full.
However, it is realised that occasionally an application
is initiated by an overseas supplier prior to the appointment
of a New Zealand agent, and then of course it is impossible
to complete all of Section 1. Cases such as this should be
explained by a covering letter, and a fully completed application
form furnished at the earliest opportunity. A Telepermit will NOT
be granted until Section 1 has been fully completed.
3. Year 2000 compliance information shall be given as one of 5 categories as follows:
4. URLs will be listed in the Telepermit Register. It is preferable
that the URLs are specific to the product rather than a general site.
SECTION 2
A company or person other than the eventual Telepermit Holder may
deal with the application process. However, the Declaration in
Section 1 must be signed by the proposed Telepermit Holder,
who is in turn responsible for the General Conditions of
Telecom Specification PTC100, and also for any special condtions
associated with the particular product.
SECTION 3
Checklist
TEST REPORT SCHEDULES
A separate schedule shall be prepared for each individual test report supplied
Test Reports
(b) Justification shall be supplied in all cases where test reports indicate
areas of non-compliance.
(c) Test Reports must cover all the functions indicated in the function list
attached to this application. Where functions have not been tested, the
application may be declined or delayed pending further Test Results, depending
on the explanation given. Alternatively it may be granted with restrictions of use.
(d) Test reports should include colour photographs. If not, a set shall
be provided separately. The photographs should show detailed views of both
external and internal features, including both sides of line interface circuit boards.
Black and white photocopies of photographs, are not acceptable.
(e) Test Reports may remain the property of a supplier, other than the
Telepermit holder, if so desired. This applies whether the supplier
is domiciled in New Zealand or overseas.
(f) Test Results against non-Telecom Specifications may be acceptable
for the purposes of obtaining a Telepermit, however the following points
must be noted:
(i) There is no guarantee that further Tests will not be required.
(ii) The difference between Telecom's PTC Specifications and other
Specifications is not static. If a particular set of extra tests meets
the Telepermit requirements on one occassion, that same set may not meet
the requirements on another occassion, as one or both of the Specifications
may have changed in the intervening period.
(iii) An extra charge for assessing the Report against non Telecom
Specifications will be levied.
A separate schedule shall be completed for EACH individual test report supplied
Test Report Details:
(A Test Report is deemed to be owned by the party for whom it was prepared. If the proposed Telepermit Holder is not that party, then it is necessary for the use of that Test Report to be formally authorised by the owner. The authorisation, on the owner's letterhead, shall be included with this Telepermit Application)
Specification:............................................................................................................................................
Test Laboratory:........................................................................................................................................
Test Report No:........................................................................................................................................
If report is held on a previous Access Standards File,
please state File Ref. No.....................................................................................................
Test Report Fully Compliant: YES/NO
If 'NO', what special circumstances should be taken into account in assessing
the product for a Telepermit:
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Test Report Owner:...................................................................................................................................
Phone:.......................................................... Fax: .............................................................
Contact Name:..............................................................................................................................
Street Address:.............................................................................................................................
(If not shown on test report)
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
Postal Address:.............................................................................................................................
(if different from street address)
....................................................................................................................................................
....................................................................................................................................................
....................................................................................................................................................
I certify that (a) I own/My company owns this test report,
or (b) I am authorised to make use
of this test report. (Copy of Authorisation to be attached)
(Delete whichever does not apply)
Signed:.................................................................. Date:...............................................
Position in company:..........................................................................................................
April 1997
1. Compliant
2. Compliant depending on software
3. No date function
4. Acceptable with adjustment
5. Non compliant
The checklist includes an indication of the type of network connection
that applies. Supporting data in accordance with the checklist
shall be provided with this application.
(Reference Section 5 of Specification PTC 100).
Failure to do so will almost certainly introduce processing delays.
(a) Test reports (not certificates) shall be in full and, wherever possible,
originals shall be supplied.
TEST REPORT SCHEDULE