1.544-MBPS/SUBRATE AFFIDAVIT
5
AFFIDAVIT FOR THE CONNECTION OF CUSTOMER EQUIPMENT TO 1.544-MBPS AND/OR
SUBRATE DIGITAL SERVICES
For the work to be performed in the certified territory of
Telco’s name: ________________________________________,
State/province of: _____________________________________,
Country of : __________________________________________,
I, _________________________, of _______________________,
(Name of Authorized Representative and Customer Name)
_____________________________________________________, _________________________,
(Customer’s Address and Telephone Number)
being duly sworn, state:
I have responsibility for the operation and maintenance of the terminal equipment to be connected to
_________________________ 1.544-Mbps and/or ___________________ Subrate digital services. The terminal equipment
to be connected complies with Part 68 of the Commission’s rules except for the encoded analog content and billing-
protection specifications. With respect to encoded analog content and billing protection:
• I attest that all operations associated with the establishment, maintenance, and adjustment of the digital CPE with
respect to encoded analog content and encoded billing information continuously complies with Part 68 of the FCC’s
Rules and Regulations.
• The encoded analog and billing protection is factory-set and is not under the control of the customer.
I attest that the operator(s)/maintainer(s) of the digital CPE responsible for the establishment, maintenance, and
adjustment of the encoded analog content and billing information has (have) been trained to perform these functions
by successfully completing at least one of the following (check all that apply):
a. A training course provided by the manufacturer/grantee of the equipment used to encode analog signals; or
b. A training course provided by the customer or authorized representative, using training materials and instructions
provided by the manufacturer/grantee of the equipment used to encode analog signals; or
c. An independent training course (at a trade school, technical institution, etc.) recognized by the manufacturer/
grantee of the equipment used to encode analog signals; or
d. In lieu of the proceeding training requirements, the operator(s)/maintainer(s) is (are) under the control of a
supervisor trained in accordance with letter ___ above.
I agree to provide ______________________________ (Telco’s Name) with proper documentation to demonstrate
compliance with the information provided in the preceding paragraph, if so requested.
______________________________________ (Signature)
______________________________________ (Title)
______________________________________ (Date)
Subscribed and sworn to me this ____ day of __________________ (month), ________ (year).
__________________________________
(Notary Public)
My commission expires:
