2BCVO-TP-C69Pisen 15W Wireless Auto Clamping Car Mount Charger

1/1 US Agent for Service of Process LETTER OF ATTESTATION TO: Office of Engineering Technology Federal Communications Commission 7435 Oakland Mills Road Columbia, MD 21046 US Agent for Service of Process: Company Name: FCC US Agent, LLC FRN: 0033402884 Contact Name: Tim Payne Address: 3722 lllinois Avenue Saint Charles, lL 60174 United States Telephone No: (708) 571-3148 Email: [email protected] Applicant: Company name: Guangdong Pisen Electronics Co., Ltd. FRN: 0034240226 Product Description: Pisen 15W Wireless Auto Clamping Car Mount Charger Grantee code: 2BCVO FCC ID: 2BCVO-TP-C69 Contact Name: Zhang Zhang Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Telephone No: 0755-28508800-8860 Email: [email protected] [Guangdong Pisen Electronics Co., Ltd.] certifies that, as of the date of this filing of the application with the TCB, [FCC US Agent, LLC] is our designated US agent for service of process for the above referenced FCC ID. [Guangdong Pisen Electronics Co., Ltd.] accepts to maintain an agent for no less than one year after the grantee has terminated all marketing and importation or the conclusion of any commission related proceeding involving equipment. [FCC US Agent, LLC] accepts, as of the date of the filing of the application, the obligation of the designated US agent for service of process for the above reference FCC ID. The US Agent for Service of Process is aware of and agrees to comply with the requirements outlined in the FCC Equipment Authorization Program, Report and Order FCC 22-84, and clause § 2.911. The Applicant is aware of and agrees to comply with the requirements outlined in the FCC Equipment Authorization Program, Report and Order FCC 22-84, and clause § 2.911. Date: 08.29.2024 Applicant’s Name: Zhang Zhang US Agent’s Name: Tim Payne Title: Manager Title: Manager Signature Signature

C5266091_X24_Ed.2 1/1 “Attestation Statements” TO: Office of Engineering Technology Federal Communications Commission 7435 Oakland Mills Road Columbia, MD 21046 The Commission adopted rules that prohibit equipment authorization for “covered” telecommunications equipment and video surveillance equipment produced by entities identified on the Commission’s Covered List 1 , which is periodically updated. See the Covered List for more details. This Attestation Statement is to confirm that we follow the Section 2.911(d)(5)(i)-(ii) Applicant Company name: Guangdong Pisen Electronics Co., Ltd. Grantee code: 2BCVO FRN: 0034240226 FCC ID: 2BCVO-TP-C69 Contact Name: Zhang Zhang Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Telephone No: 0755-28508800-8860 Fax No: 0755-28501688 Email: [email protected] i. [Guangdong Pisen Electronics Co., Ltd.] (“the applicant”) certifies that the equipment for which authorization is sought is not “covered” equipment prohibited from receiving an equipment authorization pursuant to section 2.903 of the FCC rules. The applicant must sign this certification. ii. [ Guangdong Pisen Electronics Co., Ltd.] (“the applicant”) certifies that, as of the date of the filing of the application, the applicant is not (as a specifically named entity or any of its subsidiaries or affiliates) identified on the Covered List as an entity producing “covered” equipment. The applicant must sign this certification. Guangdong Pisen Electronics Co., Ltd. certifies that, as of the date of the filing of the application, the applicant is not identified on the Covered List as an entity producing “covered” equipment. Date: 08.29.2024 Applicant’s Name: Zhang Zhang Title: Manager Signature 1 The Commission’s Covered List is published by the Public Safety and Homeland Security Bureau and posted on the Commission’s website. This Covered List, which is periodically updated, identifies particular equipment, produced by particular entities, that constitutes “covered” equipment. https://www.fcc.gov/supplychain/coveredlist

C5266091_X8_Ed.1 1/1 Letter of Authorization Company: Guangdong Pisen Electronics Co., Ltd. Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Product Name: Pisen 15W Wireless Auto Clamping Car Mount Charger Model Number: TP-C69 FCC Identifier: 2BCVO-TP-C69 We authorize LGAI Technological Center S.A., Ronda de la Font del Carme, s/n, 08193 Bellaterra, Spain, to act on our behalf on all matters concerning the above named equipment. Any individual within LGAI Technological Center S.A. is authorized to act on our behalf and take action on the application. We declare that authorize LGAI Technological Center S.A., Ronda de la Font del Carme, s/n, 08193 Bellaterra, Spain, is allowed to forward all information related to the approval project to the Federal Communication Commission and to discuss any issues concerning the approval application. Any and all acts carried out by LGAI Technological Center S.A. on our behalf shall have the same effect as acts of our own. Name: Zhang Zhang Date: 8/29/2024 Title: Manager Signature of applicant:

C5266091_X10_Ed.2 1/1 Guangdong Pisen Electronics Co., Ltd. Office of Engineering Technology Federal Communications Commission 7435 Oakland Mills Road Columbia, MD 21046 Date: 8/29/2024 Subject: Request for Confidentiality FCC ID: 2BCVO-TP-C69 To Whom It May Concern, Pursuant to the provisions of Sections 0.457 and 0.459 of Commission's rules (47CFR0.457, 0.459), we are requesting the Commission to withhold the following attachment(s) as confidential document from public disclosure. Exhibits Long-Term Confidentiality Short-Term Confidentiality NOTE 2 ID Label/Location No No Attestation Statement No No External Photos No ☐ Block Diagram ☒ ☐ Schematics ☒ ☐ Test Report No No Test Setup Photos No ☐ User’s Manual ☐ NOTE 1 ☐ Internal Photos ☐ NOTE 1 ☐ Parts List / Tune Up ☐ ☐ RF Exposure Info No No Operational Description ☒ ☐ Cover Letter(s) No No SDR Software / Security Info ☐ No NOTE 1: Long-Term Confidentiality may be permitted under special conditions (See II. LONG-TERM CONFIDENTIALITY, Section 3 of KDB 726920, use last in force) NOTE 2: Short-Term Confidentiality can be requested for a maximum of 180 days from the date of the grant. Above mentioned document contains detailed system and equipment description are considered as proprietary information in operation of the equipment. The public disclosure of above documents might be harmful to our company and would give competitor an unfair advantage in the market. In case of short-term Confidentiality, the applicant requests the exhibits selected above are withheld from public view for a period of ______ days from the date of the Grant of Equipment Authorization and prior to marketing. It is our understanding that all measurement test reports, FCC ID label format and correspondent during certification review process cannot be granted as confidential documents and those information will be available for public review once the grant of equipment authorization is issued. C5266091_X10_Ed.2 1/1 Sincerely, Signature: Name: Zhang Zhang Title: Manager

Page 1 of 3 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected] Photographs of the EUT Model: TP-C69 External Page 2 of 3 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected] Page 3 of 3 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected]

FCC ID: 2BCVO-TP-C69 FCC ID: 2BCVO-TP-C69

Page 1 of 4 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected] Photographs of the EUT Model: TP-C69 Internal Page 2 of 4 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected] Coil Page 3 of 4 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected] Page 4 of 4 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) Web: http://www.mtitest.cn E-mail: [email protected]

The test report is only used for customer scientific research, teaching, internal quality control and other purposes, and is for internal reference only. Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel : (8 6-755)88850135 Fax: (86-755) 88850136 We b : www.mtitest.cn E-mail: [email protected] Test Report Report No.: MTi240710012-04E2 Date of issue: 2024-08-09 Applicant: Guangdong Pisen Electronics Co., Ltd. Product name: Pisen 15W Wireless Auto Clamping Car Mount Charger Model(s): TP-C69 FCC ID: 2BCVO-TP-C69 Shenzhen Microtest Co., Ltd. http://www.mtitest.cn Page 2 of 14 Report No.: MTi240710012-04E2 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel : (8 6-755)88850135 Fax: (86-755) 88850136 Web: www.mtitest.cn E-mail: [email protected] Instructions 1. This test report shall not be partially reproduced without the written consent of the laboratory. 2. The test results in this test report are only responsible for the samples submitted 3. This test report is invalid without the seal and signature of the laboratory. 4. This test report is invalid if transferred, altered, or tampered with in any form without authorization. 5. Any objection to this test report shall be submitted to the laboratory within 15 days from the date of receipt of the report. Page 3 of 14 Report No.: MTi240710012-04E2 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel : (8 6-755)88850135 Fax: (86-755) 88850136 Web: www.mtitest.cn E-mail: [email protected] Contents 1 General Description ........................................................................................................................ 5 1.1 Description of the EUT ....................................................................................................................................... 5 1.2 Description of test modes ................................................................................................................................... 6 1.3 Description of support units ................................................................................................................................ 7 2 Measurement uncertainty ............................................................................................................... 7 3 Test facilities and accreditations .................................................................................................... 8 3.1 Test laboratory .................................................................................................................................................... 8 4 List of test equipment ..................................................................................................................... 9 5 Test result ...................................................................................................................................... 10 5.2 Test setup ......................................................................................................................................................... 11 5.3 Test Procedures ................................................................................................................................................ 11 5.4 Information of test equipment ........................................................................................................................... 12 5.5 Test results ....................................................................................................................................................... 13 Photographs of the Test Setup ............................................................................................................ 14 Photographs of the EUT....................................................................................................................... 14 Page 4 of 14 Report No.: MTi240710012-04E2 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel : (8 6-755)88850135 Fax: (86-755) 88850136 Web: www.mtitest.cn E-mail: [email protected] Test Result Certification Applicant: Guangdong Pisen Electronics Co., Ltd. Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Manufacturer: Guangdong Pisen Electronics Co., Ltd. Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Factory: DongGuan ChuangJie Electronics Co., Ltd. Address: No.8, Jinxing Road, Jinfenghuang Industrial District, Fenggang Town, Dongguan City Product description Product name: Pisen 15W Wireless Auto Clamping Car Mount Charger Trademark: PISEN Model name: TP-C69 Series Model: N/A Standards: FCC CFR 47 PART 1, § 1.1310 Test method: KDB 680106 D01 Wireless Power Transfer v04 Date of Test Date of test: 2024-07-26 to 2024-07-30 Te s t result: Pass Test Engineer : (James Qin) Reviewed By : (David Lee) Approved By : (Leon Chen) Page 5 of 14 Report No.: MTi240710012-04E2 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel : (8 6-755)88850135 Fax: (86-755) 88850136 Web: www.mtitest.cn E-mail: [email protected] 1 General Description 1.1 Description of the EUT Product name: Pisen 15W Wireless Auto Clamping Car Mount Charger Model name: TP-C69 Series Model: N/A Model difference: N/A Electrical rating: Intput: 5V/ 2A,9V/ 2A,12V/ 2A Output: 15W(Max) Accessories: N/A Hardware version: V1.0 Software version: V1.3 Test sample(s) number: MTi240819019-02S1001 RF specification: Operation frequency: 115-205kHz Mod…

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Fine Page 1 of 3 承認書 SPECIFICATION FOR APPROVAL 客戶： CUSTOMER: 东莞创杰电子 DongGuan ChuangJie Electronics Co., Ltd. 客 戶 料 號： CUST P/N: 音泽 料 號： FINE P/N: G50*0.8*0.08*105*L30MM-BJ 産 品 型 號： D ESC: Φ50MMX0.8MM 日期： D ATE: 2024/03/20 版本： V ersion: A.0 擬制 PREPARED BY 審核 CHECKED BY 批准 APPROVED BY 客戶承認 CUSTOMER APPROVE 何立成马莉但可清 东莞市音泽电子科技有限公司 Dongguan City Yinze Electronic Technology Co., Ltd 工廠地址：东莞市石排镇福隆教育路40号D栋3楼 Room 901, Building 2, Kangsheng Chuangfu Center, No.17 Weixing Road, Chashan Town, Dongguan City, Guangdong Province 但可清 TEL：18617251159 Fine Page 2 of 3 版本變更履歷 Version Change History 版本 Rev. 變更 前 Before Change 變 更 後 After Change 更 改 日 期 Change Date 批准 Approved By A.0 新发行 ---- 2024.03.20 但可清 Fine Page 3 of 3 SPECIFICATION 産 品 型 號： DESC G50*0.8*0.08*105*L30MM-BJ 版本 Rev：A.0 客戶CUST: 雅视韩 客户料号CUST P/N: 一、尺寸DIMENSION:(mm) 二 、原理图SCHEMATIC DIAGRAM: A 50±0.3 B 42±0.5 C 20.5±0.5 D 30±2 F 5±2 G E H I K 注： 1.交叉出线; 2.线圈贴双槽磁片，磁片尺寸 50 ±0.5mm,，厚度为 0.8±0.05mm. 3.磁片背面贴背胶 三、绕线参数Winding Specification: 序号 NO. 端子 TERMINAL 线径 WIRE 圈数 Turns 绕线方向 Winding Direction 1 S F 丝包线 0.08*105P 10Ts CCW 四、电 气特性ELECTRICAL CHARACTERISTICS: 温度TEMPERATURE:25±10°C, 湿度RELATIVE HUMIDITY:65±20% 序号 NO. 项目 ITEM 端子 TERMINAL 标准 SPECIFICATION 测试条件 TEST FREQUENCY 测试仪器 TEST EQUIPMENTS 1 IND. S-F 3 .7u H ±10%单独线圈 100KHz/1.0V LCZ METER 1062B 2 IND. S-F 6.5uH ±10%加磁片 100KHz/1.0V LCZ METER 1062B 3 DCR S-F ≤50mΩ LCZ METER 502B 擬制/日期PREPARED BY/ D AT E 審核/日期CHECKED BY/ D AT E 何立成2024.03.20

The test report is only used for customer scientific research, teaching, internal quality control and other purposes, and is for internal reference only. Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) We b : http://www.mtitest.cn E-mail: [email protected] Test Report Report No.: MTi240710012-04E1 Date of issue: 2024-08-09 Applicant: Guangdong Pisen Electronics Co., Ltd. Product name: Pisen 15W Wireless Auto Clamping Car Mount Charger Model(s): TP-C69 FCC ID: 2BCVO-TP-C69 Shenzhen Microtest Co., Ltd. http://www.mtitest.cn Page 2 of 23 Report No.: MTi240710012-04E1 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) We b : http://www.mtitest.cn E-mail: [email protected] Instructions 1. This test report shall not be partially reproduced without the written consent of the laboratory. 2. The test results in this test report are only responsible for the samples submitted 3. This test report is invalid without the seal and signature of the laboratory. 4. This test report is invalid if transferred, altered, or tampered with in any form without authorization. 5. Any objection to this test report shall be submitted to the laboratory within 15 days from the date of receipt of the report. Page 3 of 23 Report No.: MTi240710012-04E1 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) We b : http://www.mtitest.cn E-mail: [email protected] Table of contents 1 General Description ......................................................................................................................... 5 1.1 Description of the EUT ............................................................................................................................... 5 1.2 Description of test modes .......................................................................................................................... 5 1.3 Environmental Conditions .......................................................................................................................... 6 1.4 Description of support units ....................................................................................................................... 6 1.5 Measurement uncertainty .......................................................................................................................... 6 2 Summary of Test Result .................................................................................................................. 7 3 Test Facilities and accreditations ................................................................................................... 8 3.1 Test laboratory ........................................................................................................................................... 8 4 List of test equipment ...................................................................................................................... 9 5 Evaluation Results (Evaluation) .................................................................................................... 10 5.1 Antenna requirement ............................................................................................................................... 10 6 Radio Spectrum Matter Test Results (RF) .................................................................................... 11 6.1 Conducted Emission at AC power line .................................................................................................... 11 6.2 20dB Occupied Bandwidth ...................................................................................................................... 14 6.3 Emissions in frequency bands (below 30MHz)........................................................................................ 17 6.4 Emissions in frequency bands (30MHz - 1GHz)...................................................................................... 20 Photographs of the test setup ............................................................................................................. 23 Photographs of the EUT....................................................................................................................... 23 Page 4 of 23 Report No.: MTi240710012-04E1 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Community, Fuhai Street, Bao’an District, Shenzhen, Guangdong, China. Tel: 0755-88850135-1439 Mobile: 131-4343-1439 (Wechat same number) We b : http://www.mtitest.cn E-mail: [email protected] Test Result Certification Applicant: Guangdong Pisen Electronics Co., Ltd. Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Manufacturer: Guangdong Pisen Electronics Co., Ltd. Address: Building 5, 1st Floor, No. 9, Qinfu 1st Street, Liuyue Nan Community, Henggang Town, Longgang District, Shenzhen City, Guangdong Province, China Factory: DongGuan ChuangJie Electronics Co., Ltd. Address: No.8, Jinxing Road, Jinfenghuang Industrial District, Fenggang Town, Dongguan City Product description Product name: Pisen 15W Wireless Auto Clamping Car Mount Charger Trade mark: PISEN Model name: TP-C69 Series Model(s) : N/A Standards: 47 CFR Part 15C Test Method: ANSI C63.10-2013 Date of Test Date of test: 2024-07-26 to 2024-07-30 2024-07-29 to 2024-07-31 Test result: Pass Test Engineer : (James Qin) Reviewed By : (David Lee) Approved By : (Leon Chen) Page 5 of 23 Report No.: MTi240710012-04E1 Address: 101, No. 7, Zone 2, Xinxing Industrial Park, Fuhai Avenue, Xinhe Co…

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