Verilink AS4000 (34-00244) Product Manual - Manual (Page 209)

Affidavit for the Connection of Customer Premises Equipment to
1.544 Mbps and/or Subrate Digital Services
For work to be performed in the certified territory of
Telco’s Name: ___________________________________________________
State of _______________________________________________________
County of _______________________________________________________
I, ___________________________ (Authorized Representative Name), of ____________________________ (Customer Name),
_______________________________________ (Customer Address), _________________________ (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 terminal equipment to be
connected complies with Part 68 of the Commission’s rules except for the encoded analog content, and billing protection specifi-
cations. With respect to encoded analog content and billing protection:
➢ I attest that all operations associated with the establishment, maintenance, and adjustment of the digital CPE with respect to
encoded analog content and encoded billing information continuously complies with Part 68 of the FCC’s 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 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 billing information has (have) been trained to perform these functions by successfully completing
one of the following (Check the appropriate box(es) below):
❏ A. Training course provided by the manufacturer/grantee of the equipment used to encode analog signals; or
❏ B. 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. 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 _________ (choose A, B, or C) above.
I agree to provide _______________________________________ (Telco’s Name) with proper documentation to demonstrate
compliance with the information as provided in the preceding paragraph, if so requested.
________________________________________________ (Signature)
________________________________________________ (Title)
________________________________________________ (Date)
Subscribed and Sworn to before me this ______ day of ________________________, 20____.
________________________________________________
Notary Public
My Commission expires ____________________________________.