ADTRAN TSU LT User Manual page 5

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Affidavit for Connection of Customer Premises Equipment

For the work to be performed in the certified territory of ___________________ (telco name)

State of ________________

County of ________________

I, _______________________ (name), ____________________________________ (business 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 FCC rules except for the encoded analog content and billing protection

specifications. 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 analog content and encoded billing protection information continuously complies

with Part 68 of the FCC 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 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 billing 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 manufacturer/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

61202060L4-1A

to 1.544 Mbps and/or Subrate Digital Services

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