FEDERAL COMMUNCATIONS COMMISSION Approved by OMB Washington, D.C. 20554 3060-0059 STATEMENT REGARDING THE IMPORTATION OF RADIO FREQUENCY DEVICES CAPABLE O F CAUSING HARMFUL INTERFERENCE (Read instructions before completing form. Please type or print clearly in ink.) Part I - All Blocks MUST Be Completed 1 2 3 Date of Entry Entry Number Port of Entry Harmonized Tariff Number Quantity of Item (not number of containers) Device Model/Type Name or # Trade Name FCC ID Description of Equipment Manufacturers Name and Address Consignees Name and Address Importers Name and Address Printed or Typed Name of Importer or Consignee Signature of Importer or Consignee Date (Month/Day/Year) Warning: Any person who knowingly makes a false declaration may be fined not more than $250,000 or imprisoned not more than 5 years, or both, pursuant to 18 U.S.C. 1001. Part II - With Regard to the Importation of the Described Radio Frequency Device( s), I DECLARE THAT: (Place an X in only one box) 1. The FCC has issued a grant of equipment authorization for the FCC ID lis ted above. 2. An FCC grant of equipment authorization and an FCC ID are not required, but the equipment complies with FCC technical requirements. 3. The described equipment is being imported in limited quantities for test ing and evaluation for compliance with technical requirements or marketing suitability. The equipment will not be offered for sale or otherwise marketed. (See Instructions) 4. The described equipment is being imported in limited quantities for demo nstration at industry trade shows and will not be offered for sale or otherwise marketed. (See Instructions) 5. The described equipment is being imported solely for export. It will not be offered for sale or otherwise marketed in the U.S. 5(a). The described equipment is a non-U.S. standard cellular phone that can o nly function outside of the U.S. (See Instructions) 6. The described equipment is being imported for use exclusively by the U.S . Government. 7. Three or fewer radio receivers, computers, or other unintentional radiat ors as defined in Part 15 of the FCC Rules, are being imported for an individuals personal use and are not intended for sa le. 8. The described equipment is being imported for repair and will not be off ered for sale or otherwise marketed. 1. Port of Entry Use Schedule D Classification of U.S. Customs Distric ts and Ports for U.S. Foreign Trade Statistics a four digit code i. e., New York City, NY 1001. 2. Harmonized Tariff Number Harmonized Tariff Schedule of the United S tates. 3. This quantity must be total number of items, not number of containers. FCC Form 740 March 2004 American LegalNet, Inc. www.USCourtForms.com>>>> 2 INSTRUCTIONS FOR COMPLETION OF FCC FORM 740 This form must be completed for each radio frequency device, as defined in 47 U.S.C. 302 and 47 C.F.R. 2.801, which is imported into the Customs territory of the United States. The original shall be filed with the U.S Customs Service on or before th e date the shipment is delivered to a U.S. port of entry. The completed form must accompany each such entry. The following are typical examples of devices that require the use of FC C Form 740: radio and TV receivers, converters, transmitters, transmitting devices, radio frequency amplifiers, microwave ovens, indus trial heaters, ultrasonic equipment, transceivers, and computers. Marketing, as used in this form (and 47 C.F.R. 2.1201 et seq.), means sale or lease (including advertising for sale or lease, or display at a trade show) or import, ship or distribute for the purpose of selling or leasing or offering for sale or lease. Limited quantities, as used in this form, are the number specified in 47 C.F.R. 2.1204(a)(3). Waivers of this limit are infrequently granted but may be requested from the FCC office listed in 47 C.F.R. 2.1204(a) (3)(iii). Written waiver requests must contain specific information required by that office. Equipment imported for test, evaluation or display (see import conditio ns 3 or 4 of Part II of this form) may not be marketed (sold or leased, offered for sale or lease, advertised, etc.). Display of this equipment must include markings clearly indicating that the device(s) are not eligible for sale. See 47 C.F.R. 2.803 for details regarding this labeling. Wireless telephony devices that do not have a FCC grant of equipment aut horization must either comply with 47 C.F.R. 2.1204(a)(5) or 47 C.F.R. 2.803(a)(2) (e.g., Verification or Declaration of Conformity is re quired). The identification (company name and model number/FCC ID) of the radio frequency device specified on the front of this form must be identical to the company name and model number/FCC ID inscribed on the device. If the device being imported req uires an equipment authorization to be issued by the FCC (e.g., Certification), it is important that the name of the company, d escription of the device and FCC ID specified on the grant of equipment authorization agree exactly with the same information shown on the front of this form. Any discrepancy between the information on this form and the FCC grant of eq uipment authorization may result in unnecessary delays, additional expense, or enforcement action. FCC Form 740 may be reproduced provided the following conditions are met (see 47 C.F.R. 0.409, Commission Policy on Private Printing of FCC Forms.) Some of the conditions are listed below: 1. That private companies reproducing the form use a printing process resul ting in a product that is comparable to the original document; 2. That private companies reproducing the form refrain from including there in or attaching thereto any advertising matter or deleting any material from the form; 3. That private companies reproducing the form exercise care that the form being reproduced or distributed is the current edition presently used by the FCC for the type of application involved: such pri vate company to be advised that, though the Commission will endeavor to keep the public advised of revisions of the form, it cannot assume responsibility to the extent of eliminating any element or risk against overstocking, etc. PAPERWORK REDUCTION ACT STATEMENT AND PRIVACY ACT STATEMENT The solicitation of information requested on this form is authorized by the Communications Act of 1934, as amended. The information collected will be used to ascertain whether equipment authorization is r equired, and if so, whether or not it has been