Supplier’s declaration of conformity

This is the Australian Communications and Media Authority (ACMA) approved form for a declaration of conformity under thefollowing legislative instruments:>>

Radiocommunications Equipment (General) Rules 2021
Radiocommunications Labelling (Electromagnetic Compatibility) Notice 2017.

This is a sample form for a declaration of conformity under the Telecommunications (Labelling Notice for Customer Equipment and Customer
Cabling) Instrument 2015.

Instructions for completion
Do not return this form to the ACMA. This completed form must be retained by the supplier as part of the documentation required for thecompliance records. However, it must be made available for inspection by the ACMA when requested.

Supplier’s details (manufacturer, importer or authorised agent)Company name (or individual)
ACN/ARBN

N121 PTY LTD

646 997 373

Street address (Australia or New Zealand)

UNIT 5, 25-31 ALEXANDRA STREETDRUMMOYNE NSW 2047, AUSTRALIA

Product details and date of manufacture
Product description – brand name, type, current model, lot, batch or serial number (if available), software/firmware version (if applicable)

Equipment name: Tracker
Model name: FOX3-4G-M1
Brand name: LANTRONIX

Compliance – applicable standards and other supporting documents
Evidence of compliance with applicable standards may be demonstrated by test reports, endorsed/accredited test reports,
certification/competent body statements.
Having had regard to these documents, I am satisfied the above-mentioned product complies with the requirements of the relevant ACMA
standards made under the Radiocommunications Act 1992 and/or the Telecommunications Act 1997.
List these documents including details of the standard title, number and, if applicable, number of the test report/endorsed test report orcertification/competent body statement.

Standard

Report number

Radiocommunications Labelling (Electromagnetic Compatibility) Notice 2017
(AS/NZS CISPR 32: 2015+A1:2020)

AUEC238004001

Radiocommunications Equipment (General) Rules 2021

AUSC238004001

Telecommunications (Mobile Equipment Air Interface) Technical Standard 2022
(AS/CA S042.1:2022, AS/CA S042.4:2022)

C81088114

Telecommunications Technical Standard

WL-ITAV-1-22H1709-A1

Declaration
I hereby declare that:1.

I am authorised to make this declaration on behalf of the Company mentioned above2.

the contents of this form are true and correct3.

the product mentioned above complies with the applicable above mentioned standards and all products supplied under thisdeclaration will be identical to the product identified above

4.

I understand that giving false or misleading information is a serious offence.

Note: It is an offence to knowingly provide false or misleading information to a Commonwealth entity or a person who is exercising powers,
performing functions under, or in connection with, a law of the Commonwealth. It is an offence to knowingly provide false or misleading
information or documents in compliance or purported compliance with a law of the Commonwealth. (See sections 137.1 and 137.2 of theCriminal Code Act 1995.)
Penalty: 12 months imprisonment

Signature of Authorised PersonDate

Print Name

Position

February 16, 2024

DanielManaging Director

The Privacy Act 1988 (Cth) (the Privacy Act) imposes obligations on the ACMA in relation to the collection, security, quality, access, use anddisclosure of personal information. These obligations are detailed in the Australian Privacy Principles.
The ACMA may only collect personal information if it is reasonably necessary for, or directly related to, one or more of the ACMA’s functions
or activities.
The purpose of collecting the personal information in this form is to ensure the supplier is identified in the ‘declaration of conformity’. If thisdeclaration of conformity is not completed and the requested information is not provided, a compliance label cannot be applied.
Further information on the Privacy Act and the ACMA’s privacy policy is available at www.acma.gov.au/privacypolicy. The privacy policy
contains details about how you may access personal information about you that is held by the ACMA, and seek the correction of suchinformation. It also explains how you may complain about a breach of the Privacy Act and how we will deal with such a complaint.
Should you have any questions in this regard, please contact the ACMA’s privacy contact officer on telephone on 1800 226 667 or by email
at privacy@acma.gov.au.