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| 报告编号Report Number: | |
| 申请商Applicant: | |
| 地址Address of Applicant: | |
| 制造商Manufacturer: | |
| 地址Address of Manufacturer: | |
| 产品名Product Name: | |
| 额定参数Rated Specification: | |
| 型号名Model Number: | |
| Sufficient samples of the product have been tested and found to be conformity with | |
| 指令Directive | |
| 标准Test Standard: | |
| 核发日期Issued date: | |