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Applicant Declaration QSF27-14-04 Rev 1.4 April 25, 2025 Page 1 of 1 Original Issue: Jan. 4, 2021 SGS North America Inc. 620 Old Peachtree Road SUITE 100 Suwanee, Georgia 30024 United States Applicant Legal Business Name Samsung Electronics Co Ltd Address 19 Chapin Rd., Building D, Pine Brook, New Jersey, 07058, United States FRN 0027908797 Grantee Code A3L FCC ID: A3LSMR640R Authorized Contact Name Jenni Chun Contact Phone +1-973-808-6375 Contact Email [email protected] I, the undersigned, certify that I am an authorized signatory for the Applicant and therefore declare; a) in accordance with 47CFR2.911(d), all of the statements herein and the exhibits attached hereto are true and correct to the best of my knowledge and belief. b) in accepting a Grant of Equipment Authorization issued by a TCB, under the authority of the FCC, as a result of the representations made in this application, the Applicant is responsible for: (1) labeling the equipment with the exact FCC ID as specified in this application, (2) compliance statement labeling pursuant to the applicable rules, (3) compliance of the equipment with the applicable technical rules, c) if the Applicant is not the actual manufacturer of the equipment, appropriate arrangements have been made with the manufacturer to ensure that production units of this equipment will continue to comply with the FCC’s technical requirements. d) in accordance with 47 CFR 2.909 and KDB394321, the Applicant has read, understood and agrees to accept that they are the responsible party and agree to abide by their responsibilities as specified under 47 CFR 2.909 and KDB394321. e) in accordance with ISO 17065, FCC KDB641163, FCC KDB610077, KDB394321 and RSP-100, the Applicant has read, understood, accepts and agrees to abide by the post market surveillance requirements. (1) the Applicant understands, accepts and agrees that a sample may be requested for surveillance testing. (2) the Applicant shall make provisions to always have a production sample available upon request by SGS, FCC and/or ISED. (3) the Applicant shall, upon request by SGS, at the Applicant’s expense, provide a production sample of the requested product to SGS, FCC and/or ISED as instructed. The sample shall include all support devices, cables, software, accessories or other hardware or software required for evaluation, review, certification and audit surveillance of products certified by SGS. f) neither the Applicant nor any party to the application is subject to a denial of Federal benefits, that includes FCC benefits, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. §862 because of a conviction for possession or distribution of a controlled substance. See 47CFR 1.2002(b) for the definition of a “party” for these purposes. g) the Applicant has read, understood, accepts and agrees to abide by the SGS North America, Inc. terms and conditions as specified in the TCB Application Form 731 (QSF27-14-01). Link to CFRs: https://www.fcc.gov/wireless/bureau-divisions/technologies-systems-and-innovation-division/rules-regulations-title-47 Link to KDBs: https://apps.fcc.gov/oetcf/kdb/index.cfm Link to RSP-100: https://www.ic.gc.ca/eic/site/smt-gst.nsf/eng/sf01130.html Link to the Covered List: Covered List Applicant Signature: Date: 22 December, 2025 Print Name: Jenni Chun Title: General Manager *NOTE: This declaration cannot be signed by an Agent, it shall be signed by an authorized person listed in the FCC database
FCC COVERED LIST DECLARATION LETTER Page 1 of 1 Revision 1.0 SGS North America Inc. 620 Old Peachtree Road SUITE 100 Suwanee, Georgia 30024 United States Applicant Legal Business Name Samsung Electronics Co Ltd Address 19 Chapin Rd., Building D, Pine Brook, New Jersey, 07058, United States FRN 0027908797 Grantee Code A3L FCC ID: A3LSMR640R Authorized Contact Name Jenni Chun Contact Phone +1-973-808-6375 Contact Email [email protected] SEGI LIMITED (“the applicant”) certifies: - 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. - as of the date of the filing of the application, the applicant is not identified on the Covered list, established pursuant to §1.50002, as an entity producing “covered” equipment. - the software to be loaded prior to marketing of the equipment identified above is not “covered” software manufactured by any entity including predecessors, successors, parents, subsidiaries, affiliates or any entity which has rebranded or relabeled the software produced by the entity(ies) identified on the “Covered List”. - the device is not capable of storing or running software listed on the covered list and therefore is not inherently compliant. NOTE: Justification/evidence explaining how compliance is met must accompany this letter Link to the Covered List: Covered List Applicant Signature: Date: 22 December, 2025 Print Name: Jenni Chun Title: General Manager *NOTE: This declaration cannot be signed by an Agent, it shall be signed by an authorized person listed in the FCC database
UNITED STATES DESIGNATED AGENT LETTER Date: 22 December, 2025 TO: Federal Communication Commission Equipment Authorization Branch 7435 Oakland Mills Road Columbia, MID 21046 Applicant U.S. designated agent Company Name: Samsung Electronics Co Ltd Company Name: Samsung Electronics Co Ltd FRN: 0027908797 FRN: 0027908797 Grantee Code: A3L Contact Name: Jenni Chun Contact Name Jenni Chun Address: 19 Chapin Rd., Building D Address: 19 Chapin Rd., Building D City/Province/Zip: Pine Brook, New Jersey, 07058, United States City/Province/Zip: Pine Brook, New Jersey, 07058, United States Telephone: +1-973-808-6375 Telephone: +1-973-808-6375 Fax: +1-973-808-6361 Fax: +1-973-808-6361 Email: [email protected] Email: [email protected] Applicable Equipment: FCC ID: A3LSMR640R ATTN: Director of Certification: We, Samsung Electronics Co., Ltd., understand and acknowledge the applicants consent and the designated agent’s obligation to accept service of process in the United States for matters related to the applicable equipment, and at the physical U.S. address and e-mail of the designated agent listed above. We, Samsung Electronics Co., Ltd., acknowledge the applicant’s acceptance of its obligation to maintain an agent for service of process in the United States for no less than one year after either the grantee has permanently terminated all marketing and importation of the applicable equipment within the U.S., or the conclusion of any Commission-related administrative or judicial proceeding involving the equipment, whichever is later. Applicant U.S. designated agent Name (Printed): Jenni Chun Name (Printed): Jenni Chun Title: General Manager Title: General Manager Signature: Signature:
19 Chapin Rd., Building D Pine Brook, New Jersey, 07058, United States a) comply with the relevant provisions of the certification program; b) make all necessary arrangements for the conduct of the evaluation, including provision for examining documentation and access to all areas, records (including internal audit reports) and personnel for the purposes of evaluation (e.g. testing, inspection, assessment, surveillance, reassessment) and resolution of complaints; c) make claims regarding certification only in respect of the scope for which certification has been granted; d) do not use our product certification in such a manner as to bring the Certification Division into disrepute and not make any statement regarding our product certification which the Certification Division may consider misleading or unauthorized; e) upon suspension or cancellation of certification, discontinue use of all advertising matter that contains any reference thereto and return any certification documents as required by the Certification Division; f) use certification only to indicate the products are certified as being in conformity with specified standards; g) endeavor to ensure that no certificate or report nor any part thereof is used in a misleading manner; h) ensure that any reference to our product certification in communication media such as documents, brochures or advertising, complies with the requirements of the Certification Division; 22 December 2025 Federal Communications Commission Authorization and Evaluation Division 7435 Oakland Mills Road, Columbia, MD 21046 LETTER FOR AUTHORIZATION FCC ID: A3LSMR640R To whom it may concern: I, the undersigned, hereby authorize SGS Korea Co., Ltd. and hereafter referred to as SGS Korea, to act on our beha lf in all manners relating to application for equipment authorization, including signing of all documents relating to these matters. Any and all acts carried out by SGS Korea Co., Ltd. on our behalf shall have the same effect as acts of our own. I, the undersigned, hereby certify t hat we are not subject to a denial of federal benefits, that includes FCC benefits, pursuant to Section 5301 of the Anti‐Drug Abuse Act of 1988, 21 U.S.C. 853(a). In authorizing SGS Korea Co., Ltd. as our agent, we still recognize that we are responsible to: 19 Chapin Rd., Building D Pine Brook, New Jersey, 07058, United States i)keep a record of all complaints made known to the us relating to the product’s compliance with requirements of the relevant standard and to make these records available to the Certification Division when requested; j)take appropriate action with respect to such complaints and any deficiencies found in products or services that affect compliance with the requirements for certification; k)document the actions taken. This authorization is valid until further written notice from the applicant. Sincerely Yours Jenni Chun / General Manager Samsung Electronics North America INC. TEL: +1-973-808-6375 E-mail: [email protected]
19 Chapin Rd., Building D Pine Brook, New Jersey, 07058, United States 22 December 2025 Federal Communications Commission Authorization a nd Evaluation Division 7435 Oakland Mills Road, Columbia, MD 21046 REQUEST FOR CONFIDENTIALITY FCC ID: A3LSMR640R To Whom I t May Concern: Pursuant to Sections 0.457 and 0.459 of the Commission’s Rules (CFR 47), and Section 552 (b) (4) of the Freedom of Information Act , Samsung Electronics Co., Ltd. hereby requests confidentiality and treatment of cert ain information accompanying this application. The materials contain trade secrets a nd 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. We a re also hereby request Short‐Term Confidentiality for 180 days after t he grant as outlined in Public Notice DA 04‐1705. This prov ision will give Samsung Electronics Co., Ltd temporary confidentiality of commercially sensitive information prior to product release. The requested Permanent and Temporary Confidential exhibits are listed a s follows: CONFIDENTIAL LIST Permanent Block Diagram Operational Descriptions Schematics Short‐Term External Photos Internal Photos Test‐Setup Photos User Manual The Applicant understands that pursuant to Rule 0.457, disclosure of this application and all accompanying documentations, where applicable, will not be made public before the date of the Grant for this application. Sincerely Yours, Jenni Chun / General Manager Samsung Electronics North America INC. TEL: +1-973-808-63 75 E-mail: [email protected]
Label Information SM-R640 [Bottom view of charging case] Model: SM-R640 FCC ID: A3LSMR640L/A3LSMR640R IC: 649E-SMR640L/649E-SMR640R Made In Vietnam by Samsung * The device is too small to insert label, it would be in charging case. Detailed information of this model would be in user manual as well.
SGS Korea Co., Ltd. 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, 15807 Tel. 031-428-5700 / Fax. 031-427-2371 http://www.sgsgroup.kr Page : 2/60 Report File No : F690501-RF-SAR000656 Date of Issue : 2025-12-19 (All SGS services are rendered in accordance with the applicable SGS conditions of service available on request and accessible at http://www.sgs.com/en/Terms-and-Conditions.aspx.) SAR7081-04 (2020.12.15)(0) A4 (210mm x 297mm) Revision history Revision Date of issue Revisions Revised By - December 19, 2025 Initial issue - SGS Korea Co., Ltd. 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, 15807 Tel. 031-428-5700 / Fax. 031-427-2371 http://www.sgsgroup.kr Page : 3/60 Report File No : F690501-RF-SAR000656 Date of Issue : 2025-12-19 (All SGS services are rendered in accordance with the applicable SGS conditions of service available on request and accessible at http://www.sgs.com/en/Terms-and-Conditions.aspx.) SAR7081-04 (2020.12.15)(0) A4 (210mm x 297mm) Table of Contents 1. Testing Laboratory .................................................................................................................................................... 4 2. Details of Manufacturer ............................................................................................................................................ 4 3. Description of EUT(s) .............................................................................................................................................. 4 4. The Highest Reported SAR Values ........................................................................................................................... 4 5. Test Methodology ..................................................................................................................................................... 5 6. Testing Environment ................................................................................................................................................. 5 7. Specific Absorption Rate (SAR) ............................................................................................................................... 6 7.1. Introduction .................................................................................................................................................. 6 7.2. SAR Definition ............................................................................................................................................. 6 7.3. Test Standards and Limits ............................................................................................................................. 7 8. The SAR Measurement System ................................................................................................................................ 8 9. System Components ................................................................................................................................................. 9 9.1. Probe ............................................................................................................................................................. 9 9.2. SAM Phantom .............................................................................................................................................. 9 9.3. Device Holder ............................................................................................................................................... 9 10. SAR Measurement Procedures ............................................................................................................................... 10 10.1. Normal SAR Measurement Procedure ........................................................................................................ 10 11. SAR System Verification ........................................................................................................................................ 12 12. Tissue Simulant Fluid for the Frequency Band ...................................................................................................... 13 13. Instruments List ...................................................................................................................................................... 14 14. FCC Power Measurement Procedures .................................................................................................................... 15 15. Measured and Reported SAR ................................................................................................................................. 15 16. Maximum Output Power Specifications ※ .............................................................................................................. 15 17. RF Conducted Power Measurement ....................................................................................................................... 16 17.1. Bluetooth Classic Conducted Power .................................................................................................................. 16 17.2. Bluetooth LE Conducted Power ........................................................................................................................ 16 18. Bluetooth Duty Cycle used for SAR Testing .......................................................................................................... 17 18.1. Bluetooth Classic DH5 Duty Cycle ................................................................................................................... 17 18.2. Bluetooth LE 1M 255byte Duty Cycle .............................................................................................................. 18 19. SAR Data Summary ............................................................................................................................................... 19 19.1. SAR data ..........................................................................................................…
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Model name: SM-R640 Right (SM-R640R) Item Contents Antenna Type Metal Antenna Antenna peak gain -8.12 ㏈i Manufacturer / Model name S-CONNECT / DECORATION STEM Address of manufacturer building 3, No. 233, Zhongtang section Beiwang Road, Zhongtang Town,Dongguan City, Guangdong Province Provice China Test Laboratory Samsung Electronics Co., Ltd. Antenna Length 0.9 cm Antenna Width 0.2 cm Antenna Information Length Width Model name: SM-R640 Right (SM-R640R)
SGS Korea Co., Ltd. 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, Korea, 15807 Tel. +82 31 428 5700 / Fax. +82 31 427 2370 http://www.sgsgroup.kr Report Number: F690501-RF-RTL006615 Page: 2 of 48 RTT7081-02(2020.10.05)(0) A4(210 mm * 297 mm) INDEX Table of contents 1. General Information -------------------------------------------------------------------------------------- 3 2. Transmitter Radiated Spurious Emissions and Conducted Spurious Emissions ---------- 9 3. 6 ㏈ Bandwidth and 99 % Bandwidth ---------------------------------------------------------------- 32 4. Maximum Peak Conducted Output Power --------------------------------------------------------- 39 5. Power Spectral Density --------------------------------------------------------------------------------- 44 6. Antenna Requirement ----------------------------------------------------------------------------------- 48 SGS Korea Co., Ltd. 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, Korea, 15807 Tel. +82 31 428 5700 / Fax. +82 31 427 2370 http://www.sgsgroup.kr Report Number: F690501-RF-RTL006615 Page: 3 of 48 RTT7081-02(2020.10.05)(0) A4(210 mm * 297 mm) 1. General Information 1.1. Testing Laboratory SGS Korea Co., Ltd. (Gunpo Laboratory) - 10-2, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, Korea, 15807 - 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, Korea, 15807 - Designation number: KR0150 All SGS services are rendered in accordance with the applicable SGS conditions of service available on request and accessible at http://www.sgs.com/en/Terms-and-Conditions.aspx. Phone No. : +82 31 688 0901 Fax No. : +82 31 688 0921 1.2. Details of Applicant FCC Applicant : Samsung Electronics Co Ltd FCC Address : 19 Chapin Rd., Building D, Pine Brook, New Jersey, United States, 07058 IC Applicant : SAMSUNG ELECTRONICS CO. LTD. IC Address : 129 Samsung-ro, Yeongtong-gu, Suwon-Si, Gyeonggi-do, Korea (Republic Of), 16677 Contact Person : Chun, Jenni Phone No. : +1 973 808 6375 1.3. Details of Manufacturer Company : Samsung Electronics Co., Ltd. Address : 129, Samsung-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, Republic of Korea, 16677 1.4. Description of EUT Kind of Product Bluetooth Headset Model Name SM-R640 HVIN SM-R640R Serial Number Conducted: SM-R640_2 Radiated: SM-R640_4 Power Supply DC 3.85 V Frequency Range 2 402 ㎒ ~ 2 480 ㎒ (Bluetooth Low Energy) Modulation Technique GFSK Number of Channels 40 channels (Bluetooth Low Energy) Antenna Type Metal Antenna Antenna Gain ※ -8.12 ㏈i H/W Version 1.0 S/W Version R640.001 FVIN N/A SGS Korea Co., Ltd. 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, Korea, 15807 Tel. +82 31 428 5700 / Fax. +82 31 427 2370 http://www.sgsgroup.kr Report Number: F690501-RF-RTL006615 Page: 4 of 48 RTT7081-02(2020.10.05)(0) A4(210 mm * 297 mm) 1.5. Test Equipment List Equipment Manufacturer Model S/N Cal. Due Cal. Interval Signal Generator R&S SMA100B 106887 10/20/2026 Annual Spectrum Analyzer R&S FSV30 103453 10/17/2026 Annual Spectrum Analyzer Agilent N9020A MY53421758 09/10/2026 Annual Spectrum Analyzer Agilent N9030A US51350132 12/03/2026 Annual Attenuator AEROFLEX/INMET 40AH2W-10 40G-1 06/17/2026 Annual High Pass Filter Wainwright Instrument GmbH WHKX3.0/18G-10SS 21 06/17/2026 Annual High Pass Filter Wainwright Instrument GmbH WHNX7.5/26.5G-6SS 15 06/09/2026 Annual Low Pass Filter Mini-Circuits NLP-1200+ V8979400903-2 02/04/2026 Annual Power Sensor R&S NRP-Z81 100669 05/24/2026 Annual DC Power Supply R&S HMP2020 022802107 10/24/2026 Annual Preamplifier H.P. 8447F 2944A03909 08/07/2026 Annual Signal Conditioning Unit R&S SCU-18F 101058 02/27/2026 Annual Preamplifier MITEQ Inc. JS44-18004000-35-8P 1546891 10/20/2026 Annual Loop Antenna Schwarzbeck Mess-Elektronik FMZB 1519 1519-039 10/01/2027 Biennial Bilog Antenna Schwarzbeck Mess-Elektronik VULB 9163 01126 03/05/2027 Biennial Horn Antenna R&S HF906 100326 02/24/2026 Annual Horn Antenna Schwarzbeck Mess-Elektronik BBHA 9170 9170-540 12/05/2026 Annual EMI Test Receiver R&S ESU26 100109 01/13/2026 Annual Turn Table Innco systems GmbH DS 1200 S N/A N.C.R. N/A Controller Innco systems GmbH CONTROLLER CO3000-4P CO3000/963/383 30516/L N.C.R. N/A Antenna Mast Innco systems GmbH MA4640-XP-ET MA4640/536/383 30516/L N.C.R. N/A Anechoic Chamber SY Corporation L × W × H (9.6 m × 6.4 m × 6.6 m) N/A N.C.R. N/A Coaxial Cable SENSORVIEW NMST-13A26-NMST-5 m TPC2402190004 04/13/2026 Semi- Annual Coaxial Cable SENSORVIEW NMST-13A26-NMST-10 m TPC2402190001 04/13/2026 Semi- Annual Coaxial Cable RFONE PL360P-292M292M- 1.5M-A 20200324002 04/10/2026 Semi- Annual Note; For equipment listed above that has a calibration date or calibration due date that falls within the test date range, care was taken to ensure that this equipment was used after the calibration date and before the calibration due date SGS Korea Co., Ltd. 4, LS-ro 182beon-gil, Gunpo-si, Gyeonggi-do, Korea, 15807 Tel. +82 31 428 5700 / Fax. +82 31 427 2370 http://www.sgsgroup.kr Report Number: F690501-RF-RTL006615 Page: 5 of 48 RTT7081-02(2020.10.05)(0) A4(210 mm * 297 mm) 1.6. Summary of Test Results The EUT has been tested according to the following specifications: APPLIED STANDARD: FCC Part 15 Subpart C, RSS-247 Issue 4 and RSS-Gen Issue 5 Section in FCC Section in IC Test Item(s) Result 15.205(a) 15.209 15.247(d) RSS-247 Issue 4 6.6 RSS-Gen Issue 5 8.9 Transmitter Radiated Spurious Emissions and Conducted Spurious Emission Pass 15.247(a)(2) RSS-247 Issue 4 6.3.1(a) RSS-Gen Issue 5 6.7 6 ㏈ Bandwidth & 99 % Bandwidth Pass 15.247(b)(3) RSS-247 Issue 4 6.3.2 Maximum Peak Conducted Output Power Pass 15.247(e) RSS-247 Issue 4 6.3.1(b) Power Spectral Density Pass 15.207 RSS-Gen Issue 5 8.8 AC Power Line Conducted Emission N/A 1) Note; 1) The AC power line test was not performed because the EUT use battery power for operation and which do not operate from the AC power lines. 1.7. Test Procedure(s) The measurement procedures described in the American National Standard of Procedure for Compliance Testing of unlicensed Wireless Devices (ANSI …
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19 Chapin Rd., Building D · Pine Brook, New Jersey, 07058 · United States
| # | Rule Parts | Frequency Range | Power Output |
|---|---|---|---|
| 1 | 15C | 2.40 GHz - 2.48 GHz | 9.51 mW |
Bluetooth Headset
Equipment Class
DTS - Digital Transmission SystemPortable Handset
Equipment Class
CXX - Communications Rcvr for use w/ licensed Tx and CBsPortable Handset
Equipment Class
6VL - 15E 6 GHZ Very Low Power DeviceBT,BLE Tablet DTS,UNII a,b,g,n,ac,ax,be and digitizer
Equipment Class
DTS - Digital Transmission SystemPortable Handset
Equipment Class
6CD - 15E 6 GHz Low Power Dual Client