FCC 表.xls

MISSION Approved by OMB Washington, 3060 - 0059 STATEMENT REGARDING THE IMPORTATION OF RADIO FREQUENCY DEVICES CAPABLE OF CAUSING HARMFUL INTERFERENCE (Read instructions pleting form. Please type or print clearly in ink.) Part I- All Blocks MUST pleted Date of Entry Entry Number Port of Entry Harmonized Tariff Number 2 Quantity of Item(not number of containers) 3 J an11,2011 1819PCS Device Model/Type Name or# Trade Name FCC ID Description of Equipment usb flash disk , lanyard, pillow massage, laser pointer Asia ARVO 2011 Singapore USB flash disk red 1200pcs , 608pcs lanyard , 10pcs black laser pointer , 1pc red pillow massage sample Manufacturer's Name and Address Consignee Name and Address Importer Name and Address Jincheng International Industrial Limited ADD:6/F.,2nd Bldg., Lijincheng Technology Industry Park, East Industry Road,Longhua town ,Bao ’ an District , Shenzhen City Guangdong Province ,China BIZFRIEND PTE LTD ADD:8 Boon Lay Way, 8@ TradeHub 21, #11 - 11 Singapore 609964 BIZFRIEND PTE LTD ADD:8 Boon Lay Way, 8 @ TradeHub 21, #11 - 11 Singapore 609964 Printed or Typed Name of Importer or Consignee Signature of Importer or Consignee Date(Month/Day/Year) T homas J anuary,11,2011 Warning : Any person who knowingly makes a false declaration may be fined not more than $250,000 or imprisoned not more than 5 years, or both, pursuant to 18 .? 1001. Part II- Wi