Supplier s declaration of conformity As required by the following Notices: > Radiocommunications (Compliance Labelling - Devices) Notice 2014 made under section 182 of the Radiocommunications Act 1992; > Radiocommunications Labelling (Electromagnetic Compatibility) Notice 2008 made under section 182 of the Radiocommunications Act 1992 > Radiocommunications (Compliance Labelling Electromagnetic Radiation) Notice 2014 made under section 182 of the Radiocommunications Act 1992 and > Telecommunications (Labelling Notice for Customer Equipment and Customer Cabling) Instrument 2015 made under section 407 of the Telecommunications Act 1997. Instructions for completion > Do not return this form to the ACMA. This completed form must be retained by the supplier as part of the documentation required for the compliance records and must be made available for inspection by the ACMA when requested. Supplier s details (manufacturer, importer or authorised agent) Company Name (OR INDIVIDUAL) Siemens Ltd. RC-AU DF FA ACN/ARBN 98 004 347 880 OR New Zealand IRDN Street Address (AUSTRALIAN or NEW ZEALAND) 885 Mountain Highway Bayswater VIC POSTCODE 3153 Phone: 03 9721 2000 Product details and date of manufacture Product description brand name, type, current model, lot, batch or serial number (if available), software/firmware version (if applicable) Distributed Input/Output Devices ET 200S ET 200S Anschaltungsbaugruppe / Interface Modules 6ES7 151-1AA06-0AB0 6ES7 151-1AB05-0AB0 6ES7 151-1BA02-0AB0 6ES7 151-1CA00-0AB0 6ES7 151-3BA60-0AB0 6ES7 151-3BB23-0AB0 6ES7 151-7AA21-0AB0 6ES7 151-7AB00-0AB0 103_RCM_ET_200_S_A3_12_2017_d_e.docx Page 1 of 6
6ES7 151-3AA23-0AB0 6ES7 151-8AB01-0AB0 6ES7 151-3BA23-0AB0 Power Modul / Power Modules 6ES7 138-4CA01-0AA0 6ES7 138-4CA50-0AB0 6ES7 138-4CA80-0AB0 6ES7 138-4CB11-0AB0 6ES7 138-4CA60-0AB0 Digitaleingabe-/Digitalausgabe-Module / Digital Input/Output Modules 6ES7 131-4BB01-0AA0 6ES7 131-4BB01-0AB0 6ES7 131-4BD01-0AA0 6ES7 131-4BD01-0AB0 6ES7 131-4BD51-0AA0 6ES7 131-4BF00-0AA0 6ES7 131-4BF50-0AA0 6ES7 131-4CD02-0AB0 6ES7 131-4EB00-0AB0 6ES7 131-4FB00-0AB0 6ES7 131-4RD02-0AB0 6ES7 132-4BB01-0AA0 6ES7 132-4BB01-0AB0 6ES7 132-4BB31-0AA0 6ES7 132-4BB31-0AB0 6ES7 132-4BD00-0AB0 6ES7 132-4BD02-0AA0 6ES7 132-4BD30-0AB0 6ES7 132-4BD32-0AA0 6ES7 132-4BD50-0AA0 6ES7 132-4BF00-0AA0 6ES7 132-4BF00-0AB0 6ES7 132-4BF50-0AA0 6ES7 132-4FB01-0AB0 Analogeingabe-/Analogausgabe-Module / Analog Input/Output Modules 6ES7 134-4FB01-0AB0 6ES7 134-4FB52-0AB0 6ES7 134-4GB01-0AB0 6ES7 134-4GB11-0AB0 6ES7 134-4GB52-0AB0 6ES7 134-4GB62-0AB0 6ES7 134-4GD00-0AB0 6ES7 134-4LB02-0AB0 6ES7 134-4MB02-0AB0 6ES7 134-4NB01-0AB0 6ES7 134-4NB51-0AB0 6ES7 135-4FB01-0AB0 6ES7 135-4FB52-0AB0 6ES7 135-4GB01-0AB0 103_RCM_ET_200_S_A3_12_2017_d_e.docx Page 2 of 6
6ES7 134-4JB01-0AB0 6ES7 134-4JB51-0AB0 6ES7 134-4JD00-0AB0 6ES7 135-4GB52-0AB0 6ES7 135-4LB02-0AB0 6ES7 135-4MB02-0AB0 Technologie-Module / Function Modules 6ES7 138-4DA04-0AB0 6ES7 138-4DB03-0AB0 6ES7 138-4DC01-0AB0 6ES7 138-4DD01-0AB0 6ES7 138-4DF01-0AB0 6ES7 138-4DF11-0AB0 6ES7 138-4DL00-0AB0 6ES7 138-4GA50-0AB0 6ES7 138-4DE02-0AB0 Master-Interface Modul 6ES7 138-4HA00-0AB0 Potenzialverteiler-Modul / Potential Distributor Modul 6ES7 138-4FD00-0AA0 Reserve-Module / Reserve Modules 6ES7 138-4AA01-0AA0 6ES7 138-4AA11-0AA0 Terminalmodule / Terminal Modules 6ES7 193-4CA20-0AA0 6ES7 193-4CA30-0AA0 6ES7 193-4CA40-0AA0 6ES7 193-4CA50-0AA0 6ES7 193-4CA70-0AA0 6ES7 193-4CA80-0AA0 6ES7 193-4CB00-0AA0 6ES7 193-4CB10-0AA0 6ES7 193-4CB20-0AA0 6ES7 193-4CD20-0AA0 6ES7 193-4CD30-0AA0 6ES7 193-4CD70-0AA0 6ES7 193-4CE00-0AA0 6ES7 193-4CE10-0AA0 6ES7 193-4CE60-0AA0 6ES7 193-4CF40-0AA0 6ES7 193-4CF50-0AA0 6ES7 193-4CG20-0AA0 103_RCM_ET_200_S_A3_12_2017_d_e.docx Page 3 of 6
6ES7 193-4CB30-0AA0 6ES7 193-4CB60-0AA0 6ES7 193-4CB70-0AA0 6ES7 193-4CC20-0AA0 6ES7 193-4CC30-0AA0 6ES7 193-4CG30-0AA0 6ES7 193-4CK20-0AA0 6ES7 193-4CK30-0AA0 6ES7 193-4CL20-0AA0 6ES7 193-4CL30-0AA0 6ES7 193-4CC70-0AA0 Abschlußmodul / Termination Modul 6ES7 193-4JA00-0AA0 Relais-Modul / Relay-Modul 6ES7 132-4HB01-0AB0 6ES7 132-4HB50-0AB0 6ES7 132-4HB12-0AB0 Zubehörteile wurden zusammen mit den Produkten Error! Reference source not found. getestet: Accessories tested together with the products Error! Reference source not found. : Steckerzusatz / Connection Element 6ES7 193-4JB00-0AA0 6ES7 193-4JB50-0AA0 103_RCM_ET_200_S_A3_12_2017_d_e.docx Page 4 of 6
ET 200S Compact Digitaleingabe-/Digitalausgabe-Modul / Digital Input/Output Modul 6ES7 151-1CA00-3BL0 Digitaleingabe-Modul / Digital Input Modul 6ES7 151-1CA00-1BL0 Terminalmodule / Terminal Modules 6ES7 193-4DL00-0AA0 6ES7 193-4DL10-0AA0 6ES7 193-4FL00-0AA0 6ES7 193-4FL10-0AA0 Date of manufacture or importation of the original/modified item 103_RCM_ET_200_S_A3_12_2017_d_e.docx Page 5 of 6
Compliance applicable standards and other supporting documents Evidence of compliance with applicable standards may be demonstrated by test reports, endorsed/accredited test reports, certification/competent body statements. Having had regard to these documents, I am satisfied the above mentioned product complies with the requirements of the relevant ACMA Standards made under the Radiocommunications Act 1992 and the Telecommunications Act 1997. List the details of the documents the above statement was made, including the standard title, number and, if applicable, number of the test report/endorsed test report or certification/competent body statement EN 61000-6-4:2007 + A1:2011 Declaration I hereby declare that: 1. I am authorised to make this declaration on behalf of the Company mentioned above, 2. the contents of this form are true and correct, and 3. the product mentioned above complies with the applicable above mentioned standards and all products supplied under this declaration will be identical to the product identified above. Note: Under section 137.1 of the Criminal Code Act 1995, it is an offence to knowingly provide false or misleading information to a Commonwealth entity. Penalty: 12 months imprisonment SIGNATURE OF SUPPLIER OR AGENT POSITION IN ORGANISATION PRINT NAME DATE The Privacy Act 1988 (Cth) (the Privacy Act) imposes obligations on the ACMA in relation to the collection, security, quality, access, use and disclosure of personal information. These obligations are detailed in the Australian Privacy Principles. The ACMA may only collect personal information if it is reasonably necessary for, or directly related to, one or more of the ACMA s functions or activities. The purpose of collecting the personal information in this form is to ensure the supplier is identified in the Declaration of conformity. If this Declaration of Conformity is not completed and the requested information is not provided, a compliance label cannot be applied. Further information on the Privacy Act and the ACMA s Privacy Policy is available at www.acma.gov.au/privacypolicy. The Privacy Policy contains details about how you may access personal information about you that is held by the ACMA, and seek the correction of such information. It also explains how you may complain about a breach of the Privacy Act and how we will deal with such a complaint. Should you have any questions in this regard, please contact the ACMA s privacy contact officer on telephone on 1800 226 667 or by email at privacy@acma.gov.au. 103_RCM_ET_200_S_A3_12_2017_d_e.docx Page 6 of 6