Regulatory Information
Example Affidavit (United States)
Beta Draft Confidential
C-10
4/5/03
CBX 500 Multiservice WAN Switch Hardware Installation Guide
Example Affidavit (United States)
This is an example of the affidavit that needs to be filed with the Telco concerning connection of customer
premise equipment (CPE) to 1.544 Mbps services:
For the work to be performed in the certified territory of _____________________ (name of Telco), State
of _________________, County of, _______________, I, _____________________________ (Name), of
_____________________________ (Business Address), _______________(phone number) being duly
sworn, state the following:
I have responsibility for the operation and maintenance of the terminal equipment to be connected to 1.544
Mbps digital services. The terminal equipment to be connected complies with Part 68 of the FCC rules
except for the encoded analog content and billing protection specifications. With respect to the encoded
analog content and billing protection:
( ) I attest that all operations associated with the establishment, maintenance of the terminal equipment to
be connected to 1.544 Mbps digital services complies with Part 68 of the FCC Rules and Regulations.
( ) The digital CPE does not transmit digital signals containing encoded analog content or billing
information which is intended to be decoded within the telecommunications network.
( ) The encoded analog content and billing protection is factory set and is not under 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 having completed one of the following:
( ) A training course provided by the manufacturer/grantee of the equipment used to encode analog signals;
or
( ) 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
( ) An independent training course (e.g. trade school or technical institution) recognized by the
manufacturer/grantee of the equipment used to encode analog signals; or
( ) In lieu of the proceeding training requirements, the operator(s)/maintainer(s) is (are) under control of a
supervisor trained in accordance with _____ (circle one) above.
I agree to provide _________________________________ (name of Telco) with proper documentation to
demonstrate compliance with the information as provided in the preceding paragraph, if so requested.
_________________________________ (Signature)
_________________________________ (Title)
_________________________________ (Date)
Subscribe and sworn to before me, this __________ day of ____________, 19__.
__________________________ Notary Public, my commission expires __________________.
