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61200373L1-5B Issue 2, August 2001 7
Affidavit for Connection of Customer Premises
Equipment to 1.544 Mbps and/or Subrate Digital
Services
For the work to be performed in the certified territory of
________________________(telco name)
State of ________________
County of ________________
I, _____________________________ (name),
__________________________________(business ad-
dress),
____________________ (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 ter-
minal 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 en-
coded analog content and billing protection:
( ) I attest that all operations associated with the
establishment, maintenance, and adjustment of the
digital CPE with respect to analog content and
encoded billing protection information continu-
ously complies with Part 68 of the FCC Rules and
Regulations.
( ) The digital CPE does not transmit digital signals
containing encoded analog content or billing infor-
mation which is intended to be decoded within the
telecommunications network.
( ) The encoded analog content 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 bill-
ing information has (have) been trained to perform
these functions by successfully having completed one
of the following (check appropriate blocks):
( ) A. A training course provided by the manufac-
turer/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 (e.g., trade
school or technical institution) recognized by
the manufacturer/grantee of the equipment
used to encode analog signals; or
( ) D. In lieu of the preceding training requirements,
the operator(s)/maintainer(s) is (are) under the
control of a supervisor trained in accordance
with _________ (circle one) above.
I agree to provide ______________________ (telco’s
name) with proper documentation to demonstrate com-
pliance with the information as provided in the preced-
ing paragraph, if so requested.
_________________________________Signature
_________________________________Title
_________________________________ Date
Transcribed and sworn to before me
This ________ day of ________, ________
_________________________________
Notary Public
My commission expires:
_________________________________