EMVCo Mobile Product Level 1 Minor Change Declaration & Request for Publication

EMVCo Mobile Product Level 1 Minor Change Declaration & Request for Publication (for single product or family of products) Version FORMTEXT 3.0 Reference Number (for EMVCo administrative use only) Reference Number: FORMTEXT           This f orm shall be completed by a representative authorized to act on behalf of and legally bind the Product Provider. It is used to declare minor change ( s) made to each p roduct listed in Section C. Send this completed form to the EMVCo Card Type Approval Secretariat at card-approval@emvco.com. 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           Minor Change Declaration Version A.2.1 – Is this declaration an update to a previously acknowledged Minor Change Declaration ? FORMCHECKBOX Yes FORMCHECKBOX No A.2.2 – If Yes. Please provide the reference number of the previously acknowledged Minor Change Declaration FORMTEXT           A.2.3 – If Yes, Please provide the reason for updating the Minor Change Declaration FORMTEXT           B – Description/Declaration of change (s) being made to all p roducts listed in Section C

Description

Minor OS Change. FORMCHECKBOX FORMTEXT           Minor Firmware Change. FORMCHECKBOX FORMTEXT           Other FORMCHECKBOX FORMTEXT           FORMCHECKBOX For products listed in section C, I declare that only the changes specified above are being made to the product. I have determined that all of these changes are classed as minor - in accordance with the Identified Minor Changes listed in the Mobile Product Level 1 Type Approval Administrative Process. I understand that no Letter of Approval will be re-issued for these changes. C – List of Products C.1 – List of EMVCo Approved Mobile Products Derivative Product Identification C.

1.1 Technical name (mandatory) C

1. 2 Technical version 1 (mandatory) C.

1.3 ICS reference n umber 1 (mandatory) C.

1.4 Approval Number ( if available) C.

1.5 Technical name (mandatory) C.

1.6 Technical version (mandatory) C.

1.7 Request for Publication (mandatory) C.

1.8 Commercial name C.

1.9 Publication date FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           C.2 – List of Mobile Products declared with minor changes Derivative Product Identification C.

2.1 Technical name (mandatory) C

2. 2 Technical version 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 Request for Publication (mandatory) C.

2.7 Commercial name C.

2.8 Publication date FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMTEXT           FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT           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 declare minor changes 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