Request for Approval and Publication – Mobile Product Level 1

EMVCo Mobile Product Level 1 Request for Approval & Request for Publication (for single product or family of products) Date: FORMTEXT [Insert Date] EMVCo C ard Type Approval Secretariat Email: card-approval@emvco.com RE: Request for Approval – Mobile Product Level 1 Product Provider Identification A.1.1 – Company Legal Name: (As listed on the Letter of Registration) FORMTEXT           A.1.2 – EMVCo Registration Number: FORMTEXT           Mobile Product Identification Commercial name Technical name (mandatory) Technical version 2 (mandatory) Type of request (mandatory) ICS reference n umber (mandatory) Level 1 Evaluation Laboratory Level 1 Test Report Request for Publication (mandatory) Publication date FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMDROPDOWN FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           If answer to question s ‘ Request for Publication ’ is Yes and a provisional Letter of Approval was already issued, only the ‘C ommercial name ’ and the ‘Publication date’ can be updated for that (those) product(s). [Please complete and agree with the following terms] FORMCHECKBOX I hereby declare that no changes h ave been made to the referenced Mobile P roduct (s) approved under Approval Number (s) FORMTEXT [list the Approval Number(s) as provided in provisional Letter(s) of Approval] I respectfully request a n approval for Contactless Level 1 for the referenced Mobile P roduct (s). A ll documentation required for assessment by EMVCo, as described in the " EMVCo Mobile Product Level 1 Type Approval Administrative Process " is referenced above. [ Please select one of the following two sentences: ] FORMCHECKBOX I hereby declare that all the referenced Mobile P roduct ( s) currently conform to the EMV specification s described in the referenced Implementation Conformance Statement s without exception. [OR] FORMCHECKBOX I hereby declare that all the referenced Mobile P roduct ( s) currently conform to the EMV specification s described in the referenced Implementation Conformance Statement ( s) with the exception of those items specifically identified in the attached documentation, which include s an impact analysis of the non- conformance. I understand that EMVCo will not issue a Letter of Approval until all reports have been received and accepted. Sincerely, FORMTEXT [Insert Name] FORMTEXT [Insert Title] FORMTEXT [Insert Company Name]