Meer, Richard van der

Attestation FCC Application Letter

SuperCom LTD PRFPUREONE30 PCS Licensed Transmitter 2BAX3PRFPUREONE30 2BAX3PRFPUREONE30 prfpureone30

Covered List Attestation FCC ApplicationLetter

SuperCom LTD PRFPUREONE30 2BAX3PRFPUREONE30 2BAX3PRFPUREONE30 prfpureone30

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Document DEVICE REPORTPRFPUREONE30-Attestation-Statements-SuperCom-2bax3prfpureone30-ex-1-7
Covered list attestation FCC application letter Kiwa RF_755_02

Page 1 of 2 15-02-2023

[PLACE COMPANY LOGO HERE OR PUT ON COMPANY LETTERHEAD]

Certification Application Attestation Statements
SuperCom LTD 3 Rothschild St 6688106 Tel Aviv, Israel
Subject: FCC ID: 2BAX3PRFPUREONE30
To Whom It May Concern:
Statement for 47 CFR section 2.911(d)(5)(i)
SuperCom LTD certifies that as of the date of the application the equipment for which authorization is sought is
not "covered" equipment1 prohibited from receiving an equipment authorization pursuant to section 2.903 of the FCC rules.
If the equipment for which the applicant seeks authorization is produced by any of the entities identified on the current Covered List, including affiliates or subsidiaries of the named companies, the applicant must include an explanation on why the equipment is not "covered" equipment.
Additional Explanation: <N/A>

Statement for 47 CFR section 2.911(d)(5)(ii)

SuperCom LTD ("the applicant") certifies that, as of the date of the filing of this application,
the applicant
- is / - is not (3)

identified on the Covered List as an entity producing "covered" equipment.

Date: City: Name(2) : Function: Telephone number: Email address:

08-May-2023
Tel Aviv Boaz Polak Laboratory Supervisor
+972524043471 [email protected]

Signature:

1 - The Commission's Covered List is published by the Public Safety and Homeland Security Bureau and posted on the Commission's website. This Covered List, which is periodically updated, identifies particular equipment, produced by particular entities, that constitutes "covered" equipment. https://www.fcc.gov/supplychain/coveredlist .
(2): For FCC it must be the Grantee Code "owner" or the authorized agent.
(3): double click on the appropriate box and select `'checked" then "OK"

Covered list attestation FCC application letter Kiwa RF_755_02

Page 2 of 2 15-02-2023

[PLACE COMPANY LOGO HERE OR PUT ON COMPANY LETTERHEAD]

Revision Record Sheet:

Revision Section number

Page number

01

02

1

Date

Remark(s)

issued by

07-02-2023 1st version

RvM

15-02-2023

Changed Applicant to Company RvdM and added "Subject: FCC ID: "

Issued/modified by Function Revision Date
Verified by Function Date
Released by Function Date of release:

: Richard van de Meer : Certification assessor : 02 : 15-02-2023
: Willem Jan Jong : Team Lead : __-02-2023
: Axel Gase : Manager Quality Assurance : __-02-2023



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