CHECKLIST FOR DESIGNATING AUTHORITIES DESIGNATION OF NOTIFIED LABORATORY. 1. General Requirement Complies Comments

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LAMPIRAN I PERATURAN MENTERI KOMUNIKASI DAN INFORMATIKA REPUBLIK INDONESIA NOMOR TAHUN TENTANG PETUNJUK PELAKSANAAN PENGAKUAN BALAI UJI NEGARA ASING CHECKLIST FOR DESIGNATING AUTHORITIES DESIGNATION OF NOTIFIED LABORATORY 1. General Requirement Complies Comments Yes No a. Does the notified laboratory have the facilities/resources to perform conformity assessments of telecommunication devices as specified in the ministerial technical regulation, transparent, neutral, independent and impartial manner? Does the notified laboratory have the competence and ability to take full responsibility for all tasks required of a notified laboratory in relation to the Annexes of the notified laboratory application? Post designation, does the notified laboratory have a system to inform the Competent Authority of any change regarding the availability of resources

including sub-contractors that may have an implication on the designation and assignment of tasks? b. Is the notified laboratory a legally defined entity? The following to be reviewed: - documentation of the notofoed laboratory legal status - documentation which clearly shows both the authority and the responsibility of individuals within, and the reporting structure within the notified laboratory - documentation of the financial status of the notofoed laboratory c. If the notified laboratory is a legal entity, which is part of a larger organisation, is there clear documentation of the links and relationship between the notofoed laboratory and larger organisation? Where the notofoed laboratory engages the services of a subcontractor does the notified laboratory retain the responsibility of all actions undertaken by subcontractors as if the notified laboratory itself performed the tasks?

2. INDEPENDENCE REQUIREMENTS a. Are the notofoed laboratory or assessment /verification staff involved in the design, manufacture, servicing or supply, construction, marketing, installation or use, or the authorized representative of: Telecommunication device under asseeement Telecommunication devices within the scope of the audit The quality system under asseeement Are assessment and verification staff including subcontractors impartial and free from engagements and influences, which could affect their objectivity? b. Do notified laboratory or subcontracted personnel have links with the manufacturer or a competitor manufacturer of the telecommunication devices under assessment? Is this Documented? c. Have the notified laboratory or subcontracted personnel been involved in consultancy activities with the manufacturer, supplier, authorized representative or a commercial competitor of the telecommunication devices under assessment within the last 5 years?

Does marketing material for the notified laboratory give the impression that consultancy activities are offered? Does the notified laboratory have documented procedures for the identification, review, resolution and prevention of conflicts of interest where conflicts of interest are suspected or proven (including subcontracted personnel)? Does the notified laboratory keep records of such reviews and decisions? Does the notofoed laboratory require all staff acting on its behalf to declare any potential conflict of interest? If the notified laboratory is linked to an organisation that provides consultancy services, is there a documented policy/ procedure to ensure that the assessment and consultancy services are separate? 3. IMPARTIALITY REQUIREMENTS Does the notified laboratory have documented procedures to ensure the impartiality of all assessment and verification staff and that this is made known and safeguarded throughout the organization?

Does the notified laboratory implement documented procedures to ensure that the remuneration of internal and subcontracted staff is free from pressures and inducements and not dependent on the number or outcome of inspections/ verifications carried out, or the result of their activities? 4. COMPETENCE REQUIREMENTS a. Does the notified laboratory employ within its organization the necessary administrative, technical personnel which possess satisfactory knowledge and experience relating to: the telecommunication devices technologies conformity assessment procedures assigned to them. Can the notified laboratory demonstrate that the assessment and verification staff including subcontractors have knowledge and experience in the following areas as necessary for the tasks undertaken: - regulatory requirements and enforcement policies - international standardisation activities - methodology of risk analysis and risk management regarding relevant

telecommunication technology, production methods and the applicable verification procedures; the personnel shall be capable of assessing the telecommunication function and performance of devices and the processes to determine compliance with the essential requirements especially for those cases where no specific standards are available. Does the notified laboratory document the competence and training requirements for assessment and verification staff including subcontractors? Records shall be available to demonstrate that personnel have the appropriate experience and have recived appropriate training relevant to the notified laboratory s scope. c. Does the notified laboratory participate in co-ordination activities at national level in order to attain maximum coherence in performing conformity assessment? d. Does the notified laboratory carrying out Quality Assessments ensure that at least one member of the assessment team is experienced in the technologies used by the manufacturer? Does the notified laboratory ensure that at

least one member of the assessment team is trained and experienced in the following skills, as relevant to the assessment being made including: - the assessment of design documentation and evaluation data to determine that all aspects of design are in compliance with the requirements of the regulations; - the assessment of safety and performance of programmable electronic systems including software - the application of statistical controls to device verification; 5. INTERNAL PROCEDURES AND FACILITIES a. Does the notified laboratory have appropriate structures and procedures to ensure that conduct of conformity assessment and issuing of certificates is subject to a review process? Relevant procedures shall in particular address: obligations and responsibilities in relation to suspension and withdrawal of certificates, the imposition of corrective measures on manufacturers, reporting to Competent Authorities.

b. Does the notified laboratory have available the appropriate facilities to enable it to carry out the assessment and verification activities for which it has been designated? Does the notified laboratory have access to/full control of appropriately maintained testing equipment normally used by the manufacturer during testing and verification procedures? Do the facilities enable the notified laboratory to perform the technical and administrative tasks connected with evaluation and verification, whether assessment and verification activities are carried out by the notified laboratory itself or under its responsibility? Does the notified laboratory apply appropriate procedures of quality control in relation to the services provided?

LAMPIRAN II PERATURAN MENTERI KOMUNIKASI DAN INFORMATIKA REPUBLIK INDONESIA NOMOR TAHUN TENTANG PETUNJUK PELAKSANAAN PENGAKUAN BALAI UJI NEGARA ASING CERTIFICATION OF RECOGNITION Notification No : Date of Issue : Date of Expiry : This is to certify that Directorate General of Frequency Management and Equipment Standardization of Republic Indonesia has recognized.., described as Annex, to carry out conformity assessment of telecommunication equipment with the scope of designation as Annex. (Name of Director General) Director General Directorate General of Frequency Management and Equipment Standardization

LAMPIRAN III PERATURAN MENTERI KOMUNIKASI DAN INFORMATIKA REPUBLIK INDONESIA NOMOR TAHUN TENTANG PETUNJUK PELAKSANAAN PENGAKUAN BALAI UJI NEGARA ASING Annex of Notification of Recognition No.... Recognized by Republic of Indonesia Testing Laboratory Information Name of Testing Laboratory : Six-character Identifier : Physical address : Mailing address : Home page address : Name & Title of contact person : Phone : Fax : Email address :

Ministry of Communication and Information Technology Technical Regulations for which this Testing Laboratory has been recognized Technical Regulation Recognized Since Accredited Since Recognition Procedure Technical Qualification : The testing laboratory fulfils the requirements based on accreditation according to ISO/IEC 17025:2005 Title of Recognition Procedure : Regulation of Ministerial Decree Number... Year... Version Date : Accreditation Procedure Name of Accreditation Body : Accreditation Certificate Number : Date of Issue : Date of Expiry : Scope of Accreditation :