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Application for Equipment Authorization FCC Form 731 TCB Version


Applicant Information
Applicant's complete, legal business name: Fuji Film Corporation
FCC Registration Number (FRN): 0014366041
Line one: 7-3, AKASAKA 9-CHOME, MINATO-KU
Line two:
P.O. Box:
City: Tokyo
State: N/A
Country: Japan
Zip Code: 107-0052

TCB Information
TCB Application Email Address: emc.jp@ul.com
TCB Scope: A4: UNII devices & low power transmitters using spread spectrum techniques

FCC ID
Grantee Code: W2Z Product Code: -02100005

Person at the applicant's address to receive grant or for contact
First Name: Takao
Middle Name:
Last Name: Ozaki
Title:
Telephone Number: +81-3-6271-1654 Extension:
Fax Number: +81-3-6271-1189
Email: takao.ozaki@fujifilm.com
Mail Stop:


Technical Contact
Firm Name: UL Japan, Inc.
First Name: Satofumi
Middle Name:
Last Name: Matsuyama
Line 1: 4383-326 Asama-cho, Ise-shi
Line 2:
P.O. Box:
City: Mie-ken
State:
Country: Japan
Zip Code: 516-0021
Telephone Number: 81-596-24-8999 Extension:
Fax Number: 81-596-24-8124
E-Mail: Satofumi.Matsuyama@ul.com

Non Technical Contact
Firm Name:
First Name:
Middle Name:
Last Name:
Line 1:
Line 2:
P.O. Box:
City:
State:
Country:
Zip Code:
Telephone Number: Extension:
Fax Number:
E-Mail:

Long-Term Confidentiality
Does this application include a request for confidentiality for any portion(s) of the data contained in this application pursuant to 47 CFR § 0.459 of the Commission Rules?:   Yes

Short-Term Confidentiality
Does short-term confidentiality apply to this application?:   Yes
If so, specify the short-term confidentiality release date (MM/DD/YYYY format):   05/25/2018
Note: If no date is supplied, the release date will be set to 45 calendar days past the date of grant.

Software Defined/Cognitive Radio
Is this application for software defined/cognitive radio authorization?   No

Equipment Class
Equipment Class:   DTS - Digital Transmission System
Description of product as it is marketed: (NOTE: This text will appear below the equipment class on the grant): Communication module

Related OET KnowledgeDataBase Inquiry
Is there a KDB inquiry associated with this application?  No

Modular Equipment
Modular Type:  Single Modular Approval

Application Purpose
Application is for:   Class II permissive change or modification of presently authorized equipment

Composite/Related Equipment
Is the equipment in this application a composite device subject to an additional equipment authorization?   No
Is the equipment in this application part of a system that operates with, or is marketed with, another device that requires an equipment authorization?   No

Equipment Specifications
Line
Entry
Lower
Frequency
Upper
Frequency
Power
Output
Tolerance Emission
Designator
Microprocessor
Number
Rule
Parts
Grant
Notes
1 2402 2480 0.0063 15C
2 2412 2462 0.0719 15C

Test Firm Information
Name of test firm and contact person on file with the FCC:
Firm Name:   UL Japan, Inc.
First Name:   Tsuyoshi
Last Name:   Katsuda
Telephone Number: 81-596-24-8999 Extension:
Fax Number:  81-596-24-8124
E-mail:  tsuyoshi.katsuda@ul.com

Grant Comments
Enter any text that you would like to appear at the bottom of the Grant of Equipment Authorization:
Class II Permissive Change to add specific portable configuration host described in the filing. Single Modular Approval. Output power listed is Conducted(Peak). For OEM integration only - device cannot be sold to general public. Use in portable RF exposure conditions is limited to the specific product and antenna configuration evaluated in this filing (Host system : FF180001). When used in mobile applications except the conditions shown in this filing must be installed to provide a separation distance of at least 20 cm from all persons. Compliance of this device in all final host configurations is the responsibility of the Grantee. OEM integrators and end-users must be provided with specific information required to satisfy RF exposure compliance for the final host device. The antenna of this device must not be co-located or used in conjunction with any other antenna or transmitter except the conditions shown in this filing and/or in accordance with FCC multi-transmitter product guidelines. The highest reported SAR value is 0.11 W/kg : Body-worn.

Equipment Authorization Waiver
Is there an equipment authorization waiver associated with this application?  No
If there is an equipment authorization waiver associated with this application, has the associated waiver been approved and all information uploaded?:  No

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503).

SECTION 5301 (ANTI-DRUG ABUSE) CERTIFICATION:
The applicant must certify that neither the applicant nor any party to the application is subject to a denial of Federal benefits, that include FCC benefits, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. 862 because of a conviction for possession or distribution of a controlled substance. See 47 CFR 1.2002(b) for the definition of a "party" for these purposes.

Does the applicant or authorized agent so certify?  Yes

Applicant/Agent Certification:

I certify that I am authorized to sign this application. All of the statements herein and the exhibits attached hereto, are true and correct to the best of my knowledge and belief. In accepting a Grant of Equipment Authorization as a result of the representations made in this application, the applicant is responsible for (1) labeling the equipment with the exact FCC ID specified in this application, (2) compliance statement labeling pursuant to the applicable rules, and (3) compliance of the equipment with the applicable technical rules. If the applicant is not the actual manufacturer of the equipment, appropriate arrangements have been made with the manufacturer to ensure that production units of this equipment will continue to comply with the FCC's technical requirements.

Authorizing an agent to sign this application, is done solely at the applicant's discretion; however, the applicant remains responsible for all statements in this application.

If an agent has signed this application on behalf of the applicant, a written letter of authorization which includes information to enable the agent to respond to the above section 5301 (Anti-Drug Abuse) Certification statement has been provided by the applicant. It is understood that the letter of authorization must be submitted to the FCC upon request, and that the FCC reserves the right to contact the applicant directly at any time.

Signature of Authorized Person Filing:  Yoshihisa Maeda
Title of authorized signature:  Project Engineer

Complete items below if agent signs the application:

Firm Name:  UL Japan, Inc.
First Name:  Yoshihisa
Middle Name: 
Last Name:  Maeda
Line 1:  4383-326 Asama-cho, Ise-shi
Line 2: 
P.O. Box: 
City:  Mie-ken
State: 
Country: 
Zip Code:  516-0021
Telephone Number:  81-596-24-8999 Extension: 
Fax Number:  81-596-24-8124
E-mail:  Yoshihisa.Maeda@ul.com