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STATEMENT OF AUTHORIZATION

I hereby acknowledge that I am authorized to submit information to the ACTA database of Part 68 approved telephone terminal equipment (TTE) on behalf of the submitting entity or the Responsible Party, as identified in the submitted information. I further acknowledge that the information submitted is accurate, complete, and descriptive of the TTE approved for connection to the public telephone network. I understand that the submitted information is subject to a 30-day administrative audit by the ACTA or its Secretariat and I accept the responsibility to correct any errors identified within 15-days of notice from the Secretariat. I understand that any failure to correct errors identified by the Secretariat in the allotted timeframe may result in the removal of the record from the database and forfeiture of the processing fee. In addition, I understand and acknowledge that should this submission compromise the accuracy of the Part 68 database, additional processing fees may be required.