FEDERAL COMMUNICATIONS COMMISSION

Washington. DC 20554

Approved by OMI

3060 = 0059

STATEMENT REGARDING THE IMPORTATION OF RADIO FREQUENCY DEVICES

CAPABLE OF CAUSING HARMFUL INTERFERENCE

PART I – All blocks MUST Be Completed
Date of Entry		Entry Number	Port of Entry 1	Harmonised Tariff Number 2		Quantity of Item (not container)
Model/Type Name or Model/Type Number				Trade Name	FCC ID Number		Description of Equipment
Manufacture’s Name And Address				Importer’s Name and Address
Consignee’s Name and Address				Signature of Importer or Consignee				Date
				Printed or Typed Name of Importer or Consignee
WARNING: Any person Who knowingly makes a false declaration may be fined not more than $250,000 Imprisoned not more than 5 years, or both, pursuant to 18 U.S.C. 1001.
PART II. With Regard to the importation of Described Radio Frequency Device(s) I DECLARE THAT: (Place an „X“ in only one box)
	1. An equipment authorisation has been issued by the FCC.
	2. An equipment authorisation is not required but the equipment complies with FCC technical requirements.
	3. The described equipment is being imported in limited quantities for testing and evaluation for compliance with technical requirements or marketing suitability. The equipment will not be offered for sale or otherwise marketed. (See instructions.)
	4. Described equipment is being Imported in Limited quantities for demonstration at industry Trade Shows and will not be offered for sale or otherwise marketed. (See Instructions.)
	5. The described equipment is being Imported solely for export it will not be offered for sale or otherwise marketed in the U.S.
	6. The described equipment is being Imported for use exclusively by the U.S. Government.
	7. Three or fewer radio: receivers, computers, or other unintentional radiators as defined in Part 15 of the FCC Rules are being imported for an individual’s personal use and are not intended for sale.
	8. The described equipment is being imported for repair and will not be offered for sale or otherwise marketed.

1 Port of Entry Use Schedule D – Classification of U.S. Customs Districts and Ports for U.S. Foreign Trade

Statistics – a four digit code, i.e., New York City, NY.1001.

2 Harmonised Tariff Number – Harmonised Tariff Schedule of the United States.

3 This Quantity must be total number of Items, not number of containers.

FCC OF FCC form 740

FCC – 740 FORM

INSTRUCTIONS FOR COMPLETING THIS FORM

THE FOLLOWING BLOCKS NEED TO BE COMPLETED BY THE CONSIGNEE/RECIPIENT/IMPORTER:

PART 1:

(1.) MODEL OR TYPE NUMBER

(2.) TRADE NAME

(3.) DESCRIPTION OF EQUIPMENT

(4.) MANUFACTURE’S NAME AND ADDRESS

(5.) IMPORTER’S NAME AND ADDRESS (USUALLY SAME AS THE CONSIGNEE/ALWAYS A US ADDRESS)

(6.) CONSIGNEE NAME AND ADDRESS (DESTINATION ADDRESS)

(7.) SIGNATURE OF IMPORTER OR CONSIGNEE (LACK OF SIGNATURE WILL NOT RELIEVE IMPORTER/CONSIGNEE OF RESPONSIBILITY OF MAKING FALSE DECLARATION)

(8.) DATE (OF SIGNATURE)

(9.) PRINTED OR TYPED NAME OF IMPORTER OR CONSIGNEE

PART II.

PLACE AN „X“ IN THE APPROPRIATE BOX NUMBERED 1-8. (PLEASE NOTE, IF ITEM #1 S APPLICABLE, COMPLETION OF THE FCC IDENTIFIER BLOCK IN PART 1 IS EQUIRED.]