EMVCo Mobile Product Level 1 Change or Derivative Request
EMVCo Mobile Product Level 1 Change or Derivative Request (for single product or family of products) Version FORMTEXT 3.2 Reference Number and Validity Period (for EMVCo administrative use only) Reference Number: FORMTEXT Valid from: FORMTEXT Valid to: FORMTEXT This form shall be completed by a representative authorized to act on behalf of and legally bind the Product Provider. It is used to request that a change be made to each product listed in Section C. If several products are listed in Section C EMVCo will use the information provided in this form to determine whether the products can be consided a Family of Products for the described change and which testing will be required. Send the completed form to the EMVCo Card Type Approval Secretariat at card-approval@emvco.com. Once reviewed by EMVCo, the Product Provider will be advised if the change is acceptable and what additional information or steps are required to complete the review process. NOTE: Please complete this form only for changes that apply to all products defined as being in the l ist of p roducts in Section C. Any other change that does not apply to the entire list should not be declared in this form. A – Administrative Product Provider Identification A.1.1 – Company Legal Name: (As listed on the Letter of Registration) FORMTEXT A.1.2 – EMVCo Registration Number: FORMTEXT Change Request Version A.2.1 – Is this Change Request an update to a previously accepted Change Request ? FORMCHECKBOX Yes FORMCHECKBOX No A.2.2 – If Yes. Please provide the reference number of the previously accept ed Change Request FORMTEXT A.2.3 – If Yes, Please provide the reason for updating the Change Request FORMTEXT Family Identification (optional) A. 3. 1 – Family Name FORMTEXT A.3.2 – Family Version FORMTEXT B – Description /Declaration of change (s) being made to all p roducts listed in Section C
Description
CH1 Change of Proximity Payment Antenna or ferrite Materials, Location or Design. FORMCHECKBOX FORMTEXT CH2 NFC Controller Firmware Changes (analogue impact only). FORMCHECKBOX FORMTEXT CH3 Handset Software or OS Changes (analogue impact only). FORMCHECKBOX FORMTEXT CH4 NFC Controller Firmware Changes (digital impact only). FORMCHECKBOX FORMTEXT CH5 Handset Software or OS Changes (digital impact only). FORMCHECKBOX FORMTEXT CH6 NFC Controller Firmware Changes (analogue and digital impact). FORMCHECKBOX FORMTEXT CH7 Handset Software or OS Changes (analogue and digital impact). FORMCHECKBOX FORMTEXT CH8 Change of Battery (materials or size). Proximity payment antenna not on battery FORMCHECKBOX FORMTEXT CH9 Change of Battery (materials or size). Proximity payment antenna on battery FORMCHECKBOX FORMTEXT CH10 Change of Battery (add Charging Method capability -wireless transfer pack). FORMCHECKBOX FORMTEXT CH11 Handset Casing Changes FORMCHECKBOX FORMTEXT CH12 Handset PCB Changes including component changes (Replacement/Addition/removal) (analogue impact only). FORMCHECKBOX FORMTEXT CH13 Handset PCB Changes including component changes (Replacement/Addition/removal) (digital impact only). FORMCHECKBOX FORMTEXT CH14 Handset PCB Changes including component changes (Replacement/Addition/removal) (analogue and digital impact). FORMCHECKBOX FORMTEXT CH15 Addition/enablement of an EE (SWP UICC 1 or HCE or eSE or eUICC) FORMCHECKBOX FORMTEXT CH16 Addition/enablement of an EE (SWP UICC 2). FORMCHECKBOX FORMTEXT CH17 Addition of a HCE or eSE or eUICC Payment Application by the Product Provider when the standard HCE (Android) or eSE/eUICC (GP) Test Applications provided by the payment s ystems are not supported by the product FORMCHECKBOX FORMTEXT CH90 Other change not listed above and impacting the Card emulation FORMCHECKBOX FORMTEXT Additional Minor change as defined in Appendix A of the EMV® Mobile Approval Administrative Process FORMCHECKBOX FORMTEXT FORMCHECKBOX For products listed in section C, I declare that only the change s specified above are being made. C – List of Products C.1 – List of EMVCo Approved Mobile Products Changed or Derivative Product Identification C.
1.1 Technical name (mandatory) C
1. 2 Technical version NOTEREF _Ref465084685 f h * MERGEFORMAT 1 (mandatory) C.
1.3 ICS r eference n umber NOTEREF _Ref465084685 f h * MERGEFORMAT 1 (mandatory) C.
1.4 Approval Number ( if available) C.
1.5 Technical name (mandatory) C.
1.6 Technical version (mandatory) C.
1.7 Changed or Derivative product (mandatory) FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN C.2 – List of Mobile Products declared with minor changes Changed or Derivative Product Identification C. 2. 1 Technical name (mandatory) C. 2. 2 Technical version NOTEREF _Ref465085722 f h * MERGEFORMAT 3 (mandatory) C. 2. 3 Minor Change Declaration reference n umber C. 2. 4 Technical name (mandatory) C. 2. 5 Technical version (mandatory) C.
2.6 Changed or Derivative product (mandatory) FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMTEXT FORMDROPDOWN D – Rational to consider all products from Sections C as from a same family (mandatory if several products are listed in Section C) Please provide technical details and justifications that the change described in section B impacts in a similar mann er all products from Sections C FORMTEXT Completio n of this section is required (This f orm is to be completed by a representative authorized to act on behalf of and legally bind the Product Provider) The undersigned parties have entered into an EMVCo Card and Mobile Type Approval Contract ("Contract"), and desire to execute this form to describe the change made to the products listed in section C. This form is subject to all conditions as specified in the Contract. Representative’s Name: FORMTEXT Title: FORMTEXT Signature: FORMTEXT Date: FORMTEXT