Application for Equipment Approval and Filing for
Telephone Terminal Equipment by TÜV SÜD
BABT Operating as a US TCB
BABT 739
Issue 6
Page 1 of 4
Introduction
This application form should normally be used for applications for evaluation and approval of a product subject to
FCC 47 CFR part 68 by TÜV SÜD BABT as a TCB. It replaces FCC form 730 and includes and interworks with the
ACTA submission form. The form consists of a number of individual sections, which should be completed as
appropriate.
A.1
Main Contact details
Please write here the company name, and contact details to be used in the progression of the application.
Where they are the same as the responsible party listed in item 4 of the ACTA submission just state “As responsible
party”
Title: .........................
First name: .........................................
Last Name: ....................................................
(This person must be within the organisational structure of the applying company and may not be a consultant)
Job Title and/or Department Reference: ...................................................................................................................
Company Name:
...............................................................................................................................................
Address:
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
...............................................................................................................................................
Postcode/Zip Code:
........................................................
Country: ...................................................................
Prime Telephone Number: ........................................................................................................................................
Fax Number:
...............................................................................................................................................
e-mail Address:
...............................................................................................................................................
Company Web address:............................................................................................................................................
A.2
Other Contact Information
Normally all contact is directed through the main contact. If you wish to involve others for particular roles please
advise TÜV SÜD BABT with their contact details and relationship with the main contact.
In particular please mark with an “X” indicate if you require any of the following and supply the supporting information
A different Company name or address to appear on the certificate from that of the main contact
A Consultant to be involved
{A copy of the authorisation from the applicant company must be provided on company headed paper}
Section B.
Purpose of Application
Please indicate the type of assessment you require by marking all the appropriate boxes:
Application for an original
Application for a Responsible Party
Equipment approval
Code
Application for a non-Technical
Application for a technical change
change to an existing filing
to an existing filing
Where you are applying for a change, please provide the TÜV SÜD BABT Certificate number for the original
approval: Certificate number: US/......................................................................................................................
© TÜV SÜD BABT
2016
BABT is the Telecommunications
Certification body of TÜV SÜD
Application for Equipment Approval and Filing for Telephone Terminal Equipment
by TÜV SÜD BABT Operating as a US TCB BABT
B.1
739 Issue 6
Page 2 of 6
Ongoing Surveillance
Please mark with an “X” to indicate which ongoing surveillance option you wish to use:
Manufacture in a TÜV SÜD BABT Certified Manufacturing location (e.g. a location with a PQC or FQA
certificate)
Where this option is taken please indicate the Location and Certificate number of your manufacturing
location
Location: .............................................................. Cert No.: ..........................................
Under the TCB market surveillance route
Section C.
C.1
Product Details
Product name and details
Please give the product name(s) which are the subject of this application. Give the name and, if applicable the
model or catalogue number of each product. Note Where the product name in supporting documentation differs
from that detailed in item 11 of the ACTA submission form please provide an explanation (e.g. The product was
known as the “XXy” during development but will be marketed as the “ZZw”).
..........................................................................................................................................................................................
..........................................................................................................................................................................................
C.2
Brief Description of this product
Please give brief details of the purpose and type of the product. This is intended to assist in correlating the
requested certification with the degree of testing.
..........................................................................................................................................................................................
..........................................................................................................................................................................................
..........................................................................................................................................................................................
..........................................................................................................................................................................................
C.3
Additional Equipment Authorisation
Is the equipment in this application a composite device subject to an additional
equipment authorisation under another part of FCC 47 CFR (indicate as applicable)
Yes
No
If yes please indicate which one of the following is applicable
The related application has been filed at the same time as this application under the
FCC ID listed below
Yes
No
The related application has been granted under the FCC ID listed below
Yes
No
The related application is in the process of being filed under the FCC ID listed below
Yes
No
The related application is pending with the TCB/FCC under the FCC ID listed below
Yes
No
Application for Equipment Approval and Filing for Telephone Terminal Equipment
by TÜV SÜD BABT Operating as a US TCB BABT
739 Issue 6
Page 3 of 6
The FCC id of the related application is .......................................................................................... :
Section D.
Payment Details
Work is carried out on receipt of either payment in advance or a valid purchase order number. Clients applying directly to TÜV
SÜD BABT (i.e. not through any other TUV Group office), who do not currently have approved credit facilities with TÜV SÜD
BABT must include a completed Credit Details Form with the application. Alternatively payment in advance is accepted. The
appropriate forms may be downloaded from www.BABT.com
Where you wish the invoice to be sent to a different person to the main contact please mark “X” in the box
and provide the full details in supporting information.
Where you select to use a purchase order please provide your
company’s Purchase order number in the box opposite.
...............................................................................
Where you wish to pay in advance please either provide
details of your credit card or indicate you wish to select this
type of payment and contact customer.services@babt.com to
arrange for the payment.
...............................................................................
Section E.
Agreement
This section must be completed by the applicant named in Section A1
I (We) hereby apply for a Approval of a Telephone Terminal Equipment and agree to conform to the
TÜV SÜD BABT Certification Regulations
Signed for on behalf of the applicant
Authorised signatory
Name in CAPITALS
...........................................................................................
..................................................... Date: .............................................
Company Name of Authorised signatory: .....................................................................................................
All work is undertaken under TÜV SÜD BABT’s standard terms & conditions and the following specific conditions:



Certificates only relate to the product and build level of that product identified in the certificate.
Certificates are not transferable.
Changes to the Holders name or address must be notified to TÜV SÜD BABT Customer
Services in writing.
A copy of TÜV SÜD BABT’s standard terms & conditions can be found on our website
This application form must be accompanied by a completed copy of ACTA submission form and the required
information as detailed in BABT 738 ‘A guide to applying for US Equipment Approval for telephony terminal
equipment through TÜV SÜD BABT as a TCB’
Please send your application to
TÜV SÜD BABT, Forsyth House, Churchfield Road, Walton-on-Thames, Surrey, KT12 2TD, UK.
National Tel:
01932 251200
Fax:
01932 251201
International Tel
+44 1932 251200
Fax:
+44 1932 251201
Web Address:
http://www.babt.com
Email:
Customer.Service@babt.com
Application for Equipment Approval and Filing for Telephone Terminal Equipment
by TÜV SÜD BABT Operating as a US TCB BABT
739 Issue 6
Page 4 of 6
Administrative Council for Terminal Attachments
c/o
ATIS
1200 G Street, NW
Suite 500
Washington, D.C. 20005
TELEPHONE TERMINAL EQUIPMENT (TTE) SUBMISSION FORM
*Please refer to the Guidelines & Procedures for submittal of information to ACTA for inclusion in the database of
approved Telephone Terminal Equipment (“TTE”) for a detailed item description of each field.
1a.
Name of Organization Granting Approval
or Submitting Request for RPC
Company Name:
Address:
City:
NOTE: For SDoC filings only. Information of
external company filing for Responsible Party, if
applicable
Company Name:
Address:
State:
Zip:
Country:
City:
State:
Submitter’s Name:
Submitter’s Name:
Phone Number:
Phone Number:
Email Address:
Email Address:
1b.
TCB Identification Number (if applicable)
1c.
2.
Declaration of Conformity Included? (yes/no)
Terminal Approval Date
3.
Product Identifier
Zip:
Country:
4. Responsible Party
Company Name:
5.
U.S. Agent for Service
Company Name:
Address:
Individual or Department
City:
State:
Zip:
Country:
Address:
Responsible Party Point of Contact:
City:
Phone Number:
Phone:
Email Address:
URL:
6. Equipment Description
State:
Zip:
6a. Country of Origin
Application for Equipment Approval and Filing for Telephone Terminal Equipment
739 Issue 6
by TÜV SÜD BABT Operating as a US TCB BABT
Page 5 of 6
7. Responsible Party Code (RPC)
8.
Manufacturer’s Code (if available)
9. Current Authorization Number (only if
Modification, Notice, Re-certification, and/or
Re-declaration Filing)
10.
Equipment Code
11a.
List of Brand or Trade Name(s) Including New and Existing Names
11b.
List of New and Existing Model Number(s) for Each Brand or Trade Name
12. Network address signaling code
13a.
AC Ringer Equivalence Number (REN)
13b.
Hearing Aid Compatibility (YES/NO/NA)
13c.
USOC Jack(s)
13d.
Repetitive Dialling to a Single Number
(YES/NO)
14. Filing Status
15. Facility Interface Code(s)
16.
Manufacturer Port ID
17. Service Order Code(s) (SOC)
18.
Answer Supervision Code(s)
19. Ancillary Equipment
Certification
Trade Name
Status
1.
2.
3.
4.
Model Number
List of Ancillary
Equipment by Type
Manufacturer’s
Identifier
Application for Equipment Approval and Filing for Telephone Terminal Equipment
by TÜV SÜD BABT Operating as a US TCB BABT
739 Issue 6
Page 6 of 6
If you are submitting an original filing or re-certification please fill out the following information. This will
give you your ACTA Product-Labelling Number.
ACTA PRODUCT LABEL
US:
#7
#10
#13a (leave out
#3
The decimal point)
#7.
Responsible Party Code (RPC)
#10.
Equipment Code
#13a
AC Ringer Equivalence Number (REN)
#3.
Product Identifier