2ASL3-FSG200SMART SWIMMING TRACKER W/ BLUETOOTH CONN

PRODUCT INFORMATION AND SAFETY PRODUCT INFORMATION AND SAFETY PRODUCT SUPPORT Need extra help, please visit formswim.com/getstarted CLEANING • After each use and exposure to chlorine, salt water, sunscreen, and/or cosmetics, rinse the goggles with cold fresh water and allow to air dry in the included protective case, as chemicals left on the goggles may damage the materials and anti-fog coating. • DO NOT touch the inside of the goggle lens when it is dry or wipe it with a paper towel or cloth, as doing so may damage the anti-fog coating. FITTING The FORM Smart Swim Goggles are adult size. When properly adjusted, they should fit securely and comfortably with a watertight seal. The pre-installed Medium (M) nose bridge doesn’t fit all faces. If water leaks in, or if you feel tightness around your nose, try a different size nose bridge. If the nose bridge touches your nose, try one of the arched nose bridges. Note: the arched nose bridges are directional and may require reinstallation if the orientation of the goggles is changed. TIP: When you go for your first swim, take the nose bridge card in the case with you! The strap tension can be adjusted with the included buckle. Find a length that provides a snug fit without causing discomfort. WEARING The FORM Smart Swim goggles are designed to be worn like any other pair of swim goggles. To put them on: Place the goggles over your eyes. Pull the strap over your head and adjust if necessary. To take them off: Remove the strap from your head. Remove the goggles from your eyes. EYE SAFETY WARNING DO NOT pull any swim goggles away from your face without removing the strap first, as the goggles may spring back and cause eye damage. Use for surface swimming only. DO NOT use for recreational water sports or any other unintended use. DEVICE WARNINGS • DO NOT expose the goggles to detergents, solvents, chemical cleaners, or insect repellents. • DO NOT use cloth or paper to clean or dry the goggle lens, as this may cause damage. • DO NOT operate the goggles outside temperatures from 41°F to 113°F (5°C to 45°C). • DO NOT take the goggles into saunas, steam rooms, or hot tubs. • Exposure to these environments may cause permanent damage. • DO NOT store the goggles in direct sunlight or where prolonged exposure to extreme temperatures may occur. When not in use, store your goggles in the included protective case within temperatures from -4°F to 140°F (-20°C to 60°C). • The goggles will sink if dropped in water. • DO NOT use a charging cable that is not supplied or approved by FORM. • Connect the charging cable only to standard USB ports or adapters. • The charging cable is not waterproof. Make sure the goggles charging contacts and the surrounding area are completely dry before charging. HEALTH WARNINGS • Consult your physician before starting or modifying any exercise program. • If you experience unexpected pain or excessive fatigue when exercising, it is recommended that you stop the exercise. • The FORM Smart Swim goggles, accessories, and related data are intended to be used only for recreational purposes and not for medical purposes, and are not intended to diagnose, monitor, treat, cure, or prevent any disease or condition. • Heart rate measurements and data are for reference only, and no responsibility is accepted for the interpretation or consequences of any erroneous readings. • The FORM Smart Swim goggles rely on sensors that track your movement and other metrics. 4 2 1 4 3 2 1 EN 3 The data and information provided is intended to be a close estimation of your activity and metrics tracked, but may not be completely accurate. • If you experience any allergic reactions while using this product, discontinue use immediately and consult a physician. BATTERY WARNINGS This device contains a lithium-ion battery. Any unintended use or intentional disassembly may result in a risk of damage to the device, and/or injury to the user. • DO NOT attempt to remove, service or replace the non-user-replaceable battery. • DO NOT attempt to disassemble, modify, or damage the device or battery. • DO NOT expose the device or battery to fire, explosion, or other hazard. CHOKING HAZARD WARNING This product contains small parts that can be a choking hazard. This product is not suitable for children under 3 years old. REGULATORY NOTICES For all regulatory information, please visit formswim.com/regulatory To access product compliance information on your FORM Smart Swim goggles, go to: Settings > About > Regulatory This product complies with goggles and eyewear safety standards: • BS 5883:1996 Surface swimming goggles • EC 89/686/EEC directive for category 1 personal protective equipment (PPE) • ANSI Z80.3:2015 UVA/UVB 100% blocking • EN ISO 12312-1:2013(A1:2015) UVA/UVB 100% blocking • AS/NZS 1067.1:2016 UVA/UVB 100% blocking CALIFORNIA NOTICE WARNING: This product can expose you to chemicals including methylene chloride and antimony trioxide, whichare known to the State of California to cause cancer, and bisphenol A (BPA) and methanol which is known to the State of California to cause birth defects or other reproductive harm. For more information go to www.P65Warnings.ca.gov ENVIRONMENTAL POLICY AND PRODUCT RECYCLING FORM is committed to: • Protecting the environment and preventing pollution within our products’ lifecycle through responsible manufacturing and product design. • Compliance obligations with all applicable environmental legislation. • Registration with electronic equipment e-waste and packaging materials recycling programs. Electronic waste is hazardous to the environment and human health. If you have any electronic equipment at the end of its life, do not dispose of it in household waste. Please consult your local municipalities website for electronic equipment e-waste recycling programs. Separate collection and recycling of end of life electronic equipment and packaging materials helps reduce the environmental and human health impacts, and contributes to the co…

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REGULATORY NOTICES MANUFACTURER Company Name FORM Athletica Inc. Company Address 1090 Homer Street, Suite 200, Vancouver, BC V6B2W9, CANADA Brand Name FORM Website www.formswim.com Model Number FSG2 / FCH1 Product Name SMART SWIMMING TRACKER W/ BLUETOOTH CONNECTIVITY Product Type Surface swimming goggles Supplied Accessories USB charging cable, storage case Country of origin Made in Taiwan CONTENTS EU2 USA4 CANADA5 MEXICO6 JAPAN7 AUSTRALIA AND NEW ZEALAND7 TAIWAN8 1 EU EU Declaration of Conformity FORM Athletica Inc. declares that the above model numbers complies with the following: 2011/65/EU Recast Restriction on Hazardous Substances (RoHS) 2015/863/EU Amending directive on the Restriction on Hazardous Substances - Phthalates (RoHS) 1907/2006/EC ​European REACH regulation Council Directive 2014/53/EU on Radio Equipment Article 3.1a - Safety: EN 62368-1:2014/AC:2015 EN 62479: 2010 Article 3.1b - EMC: EN 301 489-1 V2.1.1 EN 301 489-17 V3.1.1 Article 3.2 - RF Spectrum Efficiency: EN 300 328 V2.1.1 Lithium ion battery: IEC 62133-2:2017 2 WEEE Disposal Information The WEEE symbol shown above indicates this product and/or its battery shall be disposed of separately from household waste according to local laws and regulations. When this product reaches its end of life, take it to a collection point designated by local authorities for safe disposal or recycling. The separate collection and recycling of your product and/or its battery at will help conserve natural resources, protect human health, and preserve the environment. 3 USA FCC ID: 2ASL3-FSG200 This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 1.This device may not cause harmful interference and 2.This device must accept any interference, including interference that may cause undesired operation of the device. FCC Warning Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: ●Reorient or relocate the receiving antenna. ●Increase the separation between the equipment and receiver. ●Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. ●Consult the dealer or an experienced radio/TV technician for help. This device meets the FCC and IC requirements for RF exposure in public or uncontrolled environments. 4 Radiation Exposure Statement The product comply with the FCC portable RF exposure limit set forth for an uncontrolled environment and are safe for intended operation as described in this manual. The further RF exposure reduction can be achieved if the product can be kept as far as possible from the user body or set the device to lower output power if such function is available. California Proposition 65 WARNING:​ This product can expose you to chemicals including methylene chloride and antimony trioxide, which are known to the State of California to cause cancer, and bisphenol A (BPA) and methanol, which is known to the State of California to cause birth defects or other reproductive harm. For more information go to ​www.P65Warnings.ca.gov CANADA IC: 24807-FSG200 Industry Canada Notifications This device complies with Industry Canada’s license-exempt RSSs. Operation is subject to the following two conditions: (1) This device may not cause interference; and (2) This device must accept any interference, including interference that may cause undesired operation of the device. Le présent appareil est conforme aux CNR d’Industrie Canada applicables aux appareils radio exempts de licence. L’exploitation est autorisée aux deux conditions suivantes: (1) l’appareil ne doit pas produire de brouillage; (2) l’utilisateur de l’appareil doit accepter tout brouillage radioélectrique subi, même si le brouillage est susceptible d’en compromettre le fonctionnement. This product meets the applicable Innovation, Science and Economic Development Canada technical specifications. 5 Le présent produit est conforme aux spécifications techniques applicables d'Innovation, Sciences et Développement économique Canada. Radiation Exposure Statement The product comply with the Canada portable RF exposure limit set forth for an uncontrolled environment and are safe for intended operation as described in this manual. The further RF exposure reduction can be achieved if the product can be kept as far as possible from the user body or set the device to lower output power if such function is available. Déclaration d'exposition aux radiations Le produit est conforme aux limites d'exposition pour les appareils portables RF pour les Etats-Unis et le Canada établies pour un environnement non contrôlé. Le produit est sûr pour un fonctionnement tel que décrit dans ce manuel. La réduction aux expositions RF peut être augmentée si l'appareil peut être conservé aussi loin que possible du corps de l'utilisateur ou que le dispositif est réglé sur la puissance de sortie la plus faible si une telle fonction est disponible. MEXICO IFETEL ID: XXXXXXXXXXXXX Mexico Information The operation of this equipment is subject to the following two conditions: (1) This equipment or device may not cause harmful interference; and…

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1090 Homer Street, Suite 200 Vancouver, BC V6B-2W9 Canada TEL: +1 604-817-2762 Date: 2020-03-20 FCC ID: 2ASL3-FSG200 FCC E-Label Information: 1. According to FCC rule part 2.925 (d) justification of using the alternative method of e-labeling for the product The location was chosen to be in the device display due to limited space available for placement of the label. The device is very small in physical size and has many contoured surfaces. The front side of the electronics enclosure is the side that the end user sees during normal operation. Form Athletica Inc. wants to reserve the front side for brand information and does not want label information on this side. For these reasons, electronic display of the FCC ID using the integrated display is the only logical choice. 2. According to KDB 784748 D02 e labeling v02 section 4, for devices with an integrated electronic display, or those devices that only operate in conjunction with another associated product that has an electronic display, below info has been stated in e-label and/or user manual. A. User Steps to Access Information Starting from Main menu: Step 1 – press the rear button to navigate to the “Settings” menu Step 2 – once in settings, use the rear button to navigate to “About” Step 3 – Finally, use the rear button to navigate to “Regulatory”, where applicable regulatory information is displayed B. Products must not require special accessories or supplemental plug-ins (e.g., the installation of a SIM/USIM card) to access the information. No special accessories or supplemental plug-ins are required to access the regulatory information Instructions will be provided with the product at the time of purchase in the Product Information and Safety Leaflet End user instructions to access product website to obtain the regulatory information is provided at the time of purchase in the Product Information and Safety Leaflet (https://formswim.com/regulatory) Readability of Regulatory Information Information on E-label In Manual FCC ID number X X FCC logo X 15.19 statement (“This device complies with part 15 of the FCC Rules. Operation is subject to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesired operation.”) X Class A / B Digital Device user manual statements X Caution to the user that changes or modifications not expressly approved by the party responsible for compliance could void the user's authority to operate the equipment X Below screens which are displayed electronically are clearly legible with no need of magnification: It is not possible to fit “FCC ID: 2ASL3-FSG200” on one line due to the low display resolution of our device. C. Regulatory Information must be Secure The regulatory information is secured and implemented in a factory-set-unalterable format. The regulatory information will be capable of being retrieved and displayed locally and accessed by the end user. There is no way for the end user to modify the regulatory information. D. Physical and Temporary label for Purchasing and Importation Although the e-label has been used, the label on the packaging at the time of importation, marketing, and sales will be as shown below: 1. 2. 3. . 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. ... E. Additional Considerations(Modular transmitters) Device is not a modular device. ----------------------------------- David Degraaf, Authorized Signatory FORM Athletica Inc. Tel: +1 604-817-2762 E-mail: [email protected]

1090 Homer Street, Suite 200 Vancouver, BC V6B-2W9 Canada TEL: +1 604-817-2762 Date: 2020-02-24 FCC ID: 2ASL3FSG200 To the attention of Federal Communications Commission Authorization and Evaluation Division Permanent Confidentiality Request Pursuant to Sections 0.457 and 0.459 of the Commission’s Rules, the Applicant hereby requests confidential treatment of information accompanying this Application as outlined below: Schematics Block Diagram Operational Description The above materials contain trade secrets and proprietary information not customarily released to the public. The public disclosure of these matters might be harmful to the Applicant and provide unjustified benefits to its competitors. The Applicant understands that pursuant to Rule 0.457, disclosure of this Application and all accompanying documentation will not be made before the date of the Grant for this application. Sincerely yours, ----------------------------------- Name: / Title: David Degraaf / Hardware Manager Tel: +1 604-817-2762 E-mail: [email protected]

1090 Homer Street, Suite 200 Vancouver, BC V6B-2W9 Canada TEL: +1 604-817-2762 Date: 2020-02-25 FCC ID: 2ASL3-FSG200 A U T H O R I Z A T I O N L E T T E R To Whom It May Concern: FORM Athletica Inc. hereby authorizes Andrea Hsia, supervisor of Bureau Veritas Consumer Products Services (H.K.) Ltd., Taoyuan Branch (“BV CPS Taoyuan”), to act on its behalf in all matters relating to the Federal Communication Commission (“FCC”) application for equipment authorization in connection with the FCC ID listed above, including signing of all documents relating to these matters. Any and all acts carried out by Andrea Hsia, supervisor of BV CPS Taoyuan on FORM Athletica Inc.’s behalf, within the scope of the powers granted herein, shall have the same effect as acts of its own. If you have any questions regarding the authorization, please don’t hesitate to contact us. Sincerely yours, ----------------------------------------------- David Degraaf, Authorized Signatory FORM Athletica Inc. Tel: +1 604-817-2762 E-mail: [email protected]

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Device display label

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FCC SAR Exclusion Report Report Format Version 5.0.0 Page No. : 1 of 8 Report No. : SF191119C01A Issued Date : Mar. 11, 2020 Reference No. : 200303C04 FCC SAR Exclusion Report Report No. : SF191119C01A Applicant : FORM Athletica Inc. Address : 1090 Homer Street, Suite 200, Vancouver, BC V6B2W9, CANADA Product : SMART SWIMMING TRACKER W/ BLUETOOTH CONNECTIVITY Brand : FORM FCC ID : 2ASL3-FSG200 Model No. : FSG2 Standards : FCC 47 CFR Part 2 (2.1093), IEEE C95.1:1992, IEEE Std 1528:2013 KDB 865664 D01 v01r04, KDB 865664 D02 v01r02, KDB 447498 D01 v06 Sample Received Date : Mar. 03, 2020 Date of Evaluation : Mar. 09, 2020 Lab Address : No. 47-2, 14th Ling, Chia Pau Vil., Lin Kou Dist., New Taipei City, Taiwan Test Location : No. 19, Hwa Ya 2nd Rd., Wen Hwa Vil., Kwei Shan Dist., Taoyuan City, Taiwan CERTIFICATION: The above equipment have been tested by Bureau Veritas Consumer Products Services (H.K.) Ltd., Taoyuan Branch – Lin Kou Laboratories, and found compliance with the requirement of the above standards. The test record, data evaluation & Equipment Under Test (EUT) configurations represented herein are true and accurate accounts of the measurements of the sample’s SAR characteristics under the conditions specified in this report. It should not be reproduced except in full, without the written approval of our laboratory. The client should not use it to claim product certification, approval, or endorsement by TAF or any government agencies. Prepared By : Rona Chen / Specialist Approved By : Gordon Lin / Manager FCC Accredited No.: TW0003 This report is for your exclusive use. Any copying or replication of this report to or for any other person or entity, or use of our name or trademark, is permitted only with our prior written permission. This report sets forth our findings solely with respect to the test samples identified herein. The results set forth in this report are not indicative or representative of the quality or characteristics of the lot from which a test sample was taken or any similar or identical product unless specifically and expressly noted. Our report includes all of the tests requested by you and the results thereof based upon the information that you provided to us. You have 60 days from date of issuance of this report to notify us of any material error or omission caused by our negligence, provided, however, that such notice shall be in writing and shall specifically address the issue you wish to raise. A failure to raise such issue within the prescribed time shall constitute your unqualified acceptance of the completeness of this report, the tests conducted and the correctness of the report contents. Unless specific mention, the uncertainty of measurement has been explicitly taken into account to declare the compliance or non-compliance to the specification. FCC SAR Exclusion Report Report Format Version 5.0.0 Page No. : 2 of 8 Report No. : SF191119C01A Issued Date : Mar. 11, 2020 Reference No. : 200303C04 Table of Contents Release Control Record ............................................................................................................................................................... 3 1.Summary of Maximum SAR Value ....................................................................................................................................... 4 2.Description of Equipment Under Test ................................................................................................................................. 5 3.SAR Measurement Evaluation .............................................................................................................................................. 6 3.1Maximum Output Power ............................................................................................................................................... 6 3.2Time-Avg. Power calculation. ....................................................................................................................................... 6 3.3SAR Testing Exclusions ............................................................................................................................................... 7 4.Information on the Testing Laboratories ............................................................................................................................. 8 Appendix A. Photographs of EUT and Setup FCC SAR Exclusion Report Report Format Version 5.0.0 Page No. : 3 of 8 Report No. : SF191119C01A Issued Date : Mar. 11, 2020 Reference No. : 200303C04 Release Control Record Issue No. Reason for Change Date Issued SF191119C01A Initial release Mar. 11, 2020 FCC SAR Exclusion Report Report Format Version 5.0.0 Page No. : 4 of 8 Report No. : SF191119C01A Issued Date : Mar. 11, 2020 Reference No. : 200303C04 1.Summary of Maximum SAR Value Equipment Class Mode Highest Reported SAR 1g (W/kg) DTS Bluetooth Not Required Note: 1.The SAR limit (Head & Body: SAR 1g 1.6 W/kg) for general population / uncontrolled exposure is specified in FCC 47 CFR part 2 (2.1093) and ANSI/IEEE C95.1-1992. FCC SAR Exclusion Report Report Format Version 5.0.0 Page No. : 5 of 8 Report No. : SF191119C01A Issued Date : Mar. 11, 2020 Reference No. : 200303C04 2.Description of Equipment Under Test EUT Type SMART SWIMMING TRACKER W/ BLUETOOTH CONNECTIVITY Brand Name FORM FCC ID 2ASL3-FSG200 Model Name FSG2 Tx Frequency Bands (Unit: MHz) 2402 ~ 2480 Uplink Modulations GFSK Maximum Tune-up Conducted Power (Unit: dBm) Please refer to section 3.1 of this report Antenna Type Ceramic SMT Antenna EUT Stage Engineering Sample Note: 1.The above EUT information is declared by manufacturer and for more detailed features description please refers to the manufacturer's specifications or User's Manual. List of Accessory: Battery Brand Name Synergy Model Name AHB581323PR Power Rating 3.7Vdc, 140mAh Type Li-ion FCC SAR Exclusion Report Report Format Version 5.0.0 Page No. : 6 of 8 Report No. : SF191119C…

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FCC SAR Exclusion Report Report Format Version 5.0.0 Report No. : SA191119C01A Reference No. : 200303C04 <Photographs of EUT> FCC SAR Exclusion Report Report Format Version 5.0.0 Report No. : SA191119C01A Reference No. : 200303C04 <Antenna Location> The separation distance for antenna to edge: Antenna To Top Side (mm) To Bottom Side (mm) To Left Side (mm) To Right Side (mm) BT Ant. 0.55 13.35 13.25 13.65 <EUT Front View> <EUT Side View (From Ant to user's Body)>

Report No.: RF191119C01 Page No. 1 / 38 Report Format Version: 6.1.1 FCC Test Report Report No.: RF191119C01 FCC ID: 2ASL3-FSG200 Test Model: FSG2 Received Date: Nov. 19, 2019 Test Date: Nov. 29, 2019 Issued Date: Dec. 05, 2019 Applicant: FORM Athletica Inc. Address: 1090 Homer Street, Suite 200, Vancouver, BC V6B2W9, CANADA Issued By: Bureau Veritas Consumer Products Services (H.K.) Ltd., Taoyuan Branch Lin Kou Laboratories Lab Address: No. 47-2, 14th Ling, Chia Pau Vil., Lin Kou Dist., New Taipei City, Taiwan Test Location: No. 19, Hwa Ya 2nd Rd., Wen Hwa Vil., Kwei Shan Dist., Taoyuan City 33383, Taiwan FCC Registration / Designation Number: 788550 / TW0003 This report is for your exclusive use. Any copying or replication of this report to or for any other person or entity, or use of our name or trademark, is permitted only with our prior written permission. This report sets forth our findings solely with respect to the test samples identified herein. The results set forth in this report are not indicative or representative of the quality or characteristics of the lot from which a test sample was taken or any similar or identical product unless specifically and expressly noted. Our report includes all of the tests requested by you and the results thereof based upon the information that you provided to us. You have 60 days from date of issuance of this report to notify us of any material error or omission caused by our negligence, provided, however, that such notice shall be in writing and shall specifically address the issue you wish to raise. A failure to raise such issue within the prescribed time shall constitute your unqualified acceptance of the completeness of this report, the tests conducted and the correctness of the report contents. Unless specific mention, the uncertainty of measurement has been explicitly taken into account to declare the compliance or non-compliance to the specification. This report should not be used by the client to claim product certification, approval, or endorsement by TAF or any government agencies. Report No.: RF191119C01 Page No. 2 / 38 Report Format Version: 6.1.1 Table of Contents Release Control Record .................................................................................................................................. 4 1 Certificate of Conformity ...................................................................................................................... 5 2 Summary of Test Results ..................................................................................................................... 6 2.1 Measurement Uncertainty ................................................................................................................... 6 2.2 Modification Record ............................................................................................................................ 6 3 General Information .............................................................................................................................. 7 3.1 General Description of EUT ................................................................................................................ 7 3.2 Description of Test Modes ................................................................................................................... 8 3.2.1 Test Mode Applicability and Tested Channel Detail ............................................................................. 9 3.3 Duty Cycle of Test Signal .................................................................................................................. 10 3.4 Description of Support Units .............................................................................................................. 11 3.4.1 Configuration of System under Test ................................................................................................... 11 3.5 General Description of Applied Standards and References .............................................................. 11 4 Test Types and Results ...................................................................................................................... 12 4.1 Radiated Emission and Bandedge Measurement ............................................................................. 12 4.1.1 Limits of Radiated Emission and Bandedge Measurement .............................................................. 12 4.1.2 Test Instruments ................................................................................................................................ 13 4.1.3 Test Procedures ................................................................................................................................. 14 4.1.4 Deviation from Test Standard ............................................................................................................ 14 4.1.5 Test Setup .......................................................................................................................................... 15 4.1.6 EUT Operating Conditions ................................................................................................................. 16 4.1.7 Test Results ....................................................................................................................................... 17 4.2 Conducted Emission Measurement ....................................…

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