Contactless Terminal Level 1 – Request for Approval / Renewal / Subsequent (RFA)

Terminal Type Approval Contact less Level 1 Request For Approval / Renewal Please return the completed and signed form to: terminal_approval@emvco.com Date: FORMTEXT insert date Our company has developed and tested the contactless device with the following identification according to EMVCo defined requirements. Therefore, we submit this request for test result evaluation and type approval consideration. Please send us a type approval invoice based on the below information. Company Name FORMTEXT insert Company Name EMVCo L 1 Vendor Registration Number FORMTEXT insert L1 Vendor Registration Number PCD Identification: Name and Version FORMTEXT insert PCD Id Terminal/Card Reader in which the PCD was tested FORMTEXT insert specific terminal model used for testing PCD Product status FORMTEXT Initial/Renewal/Subsequent Implementation Conformance Statement FORMTEXT insert ICS Reference Number Tested at Laboratory FORMTEXT insert accredited laboratory name EMV Specification Version FORMTEXT insert specification date and version # √ We hereby agree with the report content as will be submitted by the above mentioned laboratory. √ The ICS referenced truly reflects the capabilities of our PCD. A copy of all required documentation as listed in the "EMVCo Type Approval – Contact less Terminal Level 1 – Administrative Process" documentation is attached for evaluation by EMVCo. Sincerely, Name: FORMTEXT insert name Position: FORMTEXT insert position Signature: FORMTEXT