ORIGIN 3. REQUIRED ITEMS (i) (ii) (iii) (iv) (v) (vi) 4. Letter of Agency from manufacturer or principal distributor. Non-refundable approval/acceptable fee of Ksh.............vide Receipt No.............of.................. Sample of equipment/instrument model complete with associated accessories and attachments. Detailed technical documentation (operation, programming, service, technical, circuitry) in English language. Test report (Results) from manufacturer or accredited laboratories and test schedules. List from manufacturer stating other countries where the equipment is type approved and in service. DECLARATION I hereby apply for provisional Type Approval/Acceptance / authority to market the equipment(s) specified above in Kenya on behalf of my company. I certify that all the information I have given in this form is correct to the best of my knowledge. Applicant’s Name..........................................Sign.........................Date............................... Contact Tel No.......................................... 5. FOR OFFICIAL USE ONLY (i) (ii) (iii) (iv) Case No............................................. Evaluating officers name...........................Sign............................. Approval Recommended/Not Recommended (Delete where not applicable). TAC No................ Approved/Not Approved/Deferred (Delete where applicable) Form No.3 Regulations 57 COMMUNICATIONS COMMISSION OF KENYA 79