Authority To Act As Agent (Page 2 of 2) in pdf

THIS MUST BE SIGNED BY THE APPLICANT/AGENT AND SHOULD BE

PLACED ON APPROPRIATE LETTERHEAD

Request for Confidentiality

Date: ________

Subject: Confidentiality Request for: ______(Insert FCC ID and/or IC ID)______

Pursuant to FCC 47 CRF 0.457(d) and 0.459 and IC RSP-100, Section 6.4, the applicant requests that a part of the

subject FCC application be held confidential.

Type of Confidentiality Requested

Exhibit

Short Term

Permanent

Block Diagrams

Short Term

External Photos

Short Term

Permanent*

Internal Photos

Short Term

Permanent

Operation Description/Theory of Operation

Short Term

Permanent

Parts List & Placement/BOM

Short Term

Permanent

Tune-Up Procedure

Short Term

Permanent

Schematics

Short Term

Test Setup Photos

User’s Manual

Short Term

Permanent*

______(Insert Company Name)______ has spent substantial effort in developing this product and it is one of the first

of its kind in industry. Having the subject information easily available to "competition" would negate the advantage

they have achieved by developing this product. Not protecting the details of the design will result in financial

hardship.

Permanent Confidentiality:

The applicant requests the exhibits listed above as permanently confidential be permanently withheld from public

review due to materials that contain trade secrets and proprietary information not customarily released to the public.

Short-Term Confidentiality:

The applicant requests the exhibits selected above as short term confidential be withheld from public view for a

period of ___(specify number of days not to exceed 180)

___ days from the date of the Grant of Equipment

Authorization and prior to marketing. This is to avoid premature release of sensitive information prior to marketing

or release of the product to the public. Applicant is also aware that they are responsible to notify ACB in the event

information regarding the product or the product is made available to the public. ACB will then release the

documents listed above for public disclosure pursuant to FCC Public Notice DA 04-1705.

NOTE for Industry Canada Applications:

IC currently only distinguishes Permanent Confidentiality exhibits as shown above. Short Term confidentiality is not

considered applicable to IC applications.

Sincerely,

By:

__________________________

________________________

(Signature/Title

)

(Print name)

- The asterisked items (*) require further information to be provided to ACB before permanent confidentiality will be

extended to these exhibits. Please refer to FCC KDB 726920 and the specific Document link for D01 found at:

https://apps.fcc.gov/oetcf/kdb/forms/FTSSearchResultPage.cfm?switch=P&id=41731

and review section V regarding

EXCEPTIONAL CIRCUMSTANCES. As of the October 2014 version of this document, TCB’s can not authorize these

requests. The applicant should petition the FCC by submitting an inquiry as directed. A copy of this inquiry and the FCC’s

response must be provided with the application.

- Please refer to

for complete

details.

Must be signed by applicant contact given for applicant on the FCC site, or by the authorized agent if an appropriate

authorized agent letter has been provided. Letters should be placed on appropriate letterhead.

020415 – 08

Authority To Act As Agent Page 2

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