FCC ID 2ASL3-FSG100

2ASL3FSG100, 2ASL3 FSG100, 2ASL3-FSG100, 2ASL3-FSG1OO, 2ASL3-FSGI00, 2ASL3-F5G100, 2A5L3-F5G100

Form Athletica Swimming goggles with heads-up display w/ Bluetooth Low Energy capability. FSG100

An FCC ID is the product ID assigned by the FCC to identify wireless products in the market. The FCC chooses 3 or 5 character "Grantee" codes to identify the business that created the product. For example, the grantee code for FCC ID: 2ASL3-FSG100 is 2ASL3. The remaining characters of the FCC ID, -FSG100, are often associated with the product model, but they can be random. These letters are chosen by the applicant. In addition to the application, the FCC also publishes internal images, external images, user manuals, and test results for wireless devices. They can be under the "exhibits" tab below.

Purchase on Amazon: Swimming goggles with heads-up display w/ Bluetooth Low Energy capability.

Application: Swimming goggles with heads-up display w/ Bluetooth Low Energy capability.
Equipment Class: DTS - Digital Transmission System
Short Link: fcc.id/2ASL3-FSG100
Sources: FCC.gov | FCC.report
Registered By: Form Athletica - 2ASL3 (Canada)

App #	Purpose	Date	Unique ID
1	Original Equipment	2019-05-08	K2Jqm35mHzpS8Pukd0A2QA==

Operating Frequencies

Frequency Range	Power Output	Rule Parts	Line Entry
2.402-2.48 GHz	3.28 mW	15C	1

Exhibits

Document	Type	Submitted Available
Test Report	Test Report Adobe Acrobat PDF (2329 kB)	2019-05-08 2019-05-08
Confidentiality Request Letter Short Term	Cover Letter(s) Adobe Acrobat PDF (143 kB)	2019-05-15 2019-05-08
Label Location	ID Label/Location Info Adobe Acrobat PDF (217 kB)	2019-05-08 2019-05-08
Test Setup Photos	Test Setup Photos Adobe Acrobat PDF (374 kB)	2019-05-08 2019-11-04
Confidentiality Request Letter	Cover Letter(s) Adobe Acrobat PDF (88 kB)	2019-05-08 2019-05-08
Letter POA	Cover Letter(s) Adobe Acrobat PDF (756 kB)	2019-05-08 2019-05-08
Justification for Label Location	Cover Letter(s) Adobe Acrobat PDF (36 kB)	2019-05-08 2019-05-08
Label Sample	ID Label/Location Info Adobe Acrobat PDF (970 kB)	2019-05-08 2019-05-08
External Photos	External Photos Adobe Acrobat PDF (744 kB)	2019-05-08 2019-11-04
Internal Photos	Internal Photos Adobe Acrobat PDF (1108 kB)	2019-05-08 2019-11-04
User Manual	Users Manual Adobe Acrobat PDF (507 kB)	2019-05-08 2019-11-04
Schematics	Schematics Adobe Acrobat PDF (2614 kB)	2019-05-08
Block Diagram	Block Diagram Adobe Acrobat PDF (44 kB)	2019-05-08
Operational Description	Operational Description Adobe Acrobat PDF (310 kB)	2019-05-08
Users Manual BOM	Parts List/Tune Up Info Adobe Acrobat PDF (35 kB)	2019-05-08
Operational Description Antenna Info	Operational Description Adobe Acrobat PDF (293 kB)	2019-05-08

Application Forms

1 (2019-05-08)

Application for Equipment Authorization FCC Form 731 TCB Version

Applicant Information

Applicant's complete, legal business name:	Form Athletica
FCC Registration Number (FRN):	0028285013
Alphanumeric FCC ID:	2ASL3FSG100
Unique Application Identifier:	K2Jqm35mHzpS8Pukd0A2QA==
Line one:	1090 Homer Street Suite 200
City:	Vancouver
State:	N/A
Country:	Canada

TCB Information

TCB Application Email Address:	tei@timcoengr.com
TCB Scope:	A4: UNII devices & low power transmitters using spread spectrum techniques

FCC ID

Grantee Code:	2ASL3
Product Code:	-FSG100

Person at the applicant's address to receive grant or for contact

Name:

David Degraaf

Telephone Number:

6048172762

Extension:

Fax Number:	6048172762
Email:	david@formathletica.com

Long-Term Confidentiality

Does this application include a request for confidentiality for any portion(s) of the data contained in this application pursuant to 47 CFR § 0.459 of the Commission Rules?: Yes

Short-Term Confidentiality

Does short-term confidentiality apply to this application?: No

If so, specify the short-term confidentiality release date (MM/DD/YYYY format):
Note: If no date is supplied, the release date will be set to 45 calendar days past the date of grant.

Software Defined/Cognitive Radio

Is this application for software defined/cognitive radio authorization? No

Equipment Class

Equipment Class: DTS - Digital Transmission System
Description of product as it is marketed: (NOTE: This text will appear below the equipment class on the grant):	Swimming goggles with heads-up display w/ Bluetooth Low Energy capability.

Related OET KnowledgeDataBase Inquiry

Is there a KDB inquiry associated with this application? No

Modular Equipment

Modular Type: Does not apply

Application Purpose

Application is for: Original Equipment

Composite/Related Equipment

Is the equipment in this application a composite device subject to an additional equipment authorization? No

Is the equipment in this application part of a system that operates with, or is marketed with, another device that requires an equipment authorization? No

Test Firm Information

Name of test firm and contact person on file with the FCC:

Firm Name: QAI LABORATORIES LTD.

First Name: Parminder

Last Name: Singh

Telephone Number:

604-527-8378

Extension:

Fax Number: 604-527-8368

E-mail: psingh@qai.org

Grant Comments

Enter any text that you would like to appear at the bottom of the Grant of Equipment Authorization:
Power listed is conducted.

Set the grant of this application to be deferred to a specified date:
No

Equipment Authorization Waiver

Is there an equipment authorization waiver associated with this application? No

If there is an equipment authorization waiver associated with this application, has the associated waiver been approved and all information uploaded?: No

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND IMPRISONMENT (U.S. CODE, TITLE 18, SECTION 1001), AND/OR REVOCATION OF ANY STATION LICENSE OR CONSTRUCTION PERMIT (U.S. CODE, TITLE 47, SECTION 312(a)(1)), AND/OR FORFEITURE (U.S. CODE, TITLE 47, SECTION 503).

SECTION 5301 (ANTI-DRUG ABUSE) CERTIFICATION:

The applicant must certify that neither the applicant nor any party to the application is subject to a denial of Federal benefits, that include 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 47 CFR 1.2002(b) for the definition of a "party" for these purposes.

Does the applicant or authorized agent so certify? Yes

Applicant/Agent Certification:

I certify that I am authorized to sign this application. All of the statements herein and the exhibits attached hereto, are true and correct to the best of my knowledge and belief. In accepting a Grant of Equipment Authorization as a result of the representations made in this application, the applicant is responsible for (1) labeling the equipment with the exact FCC ID specified in this application, (2) compliance statement labeling pursuant to the applicable rules, and (3) compliance of the equipment with the applicable technical rules. 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.

Authorizing an agent to sign this application, is done solely at the applicant's discretion; however, the applicant remains responsible for all statements in this application.

If an agent has signed this application on behalf of the applicant, a written letter of authorization which includes information to enable the agent to respond to the above section 5301 (Anti-Drug Abuse) Certification statement has been provided by the applicant. It is understood that the letter of authorization must be submitted to the FCC upon request, and that the FCC reserves the right to contact the applicant directly at any time.

Signature of Authorized Person Filing: David Degraaf

Title of authorized signature: Hardware Manager

Applications are submitted for FCC ID and Grant requests. Click an above application to view details

TCB	GRANT OF EQUIPMENT AUTHORIZATION	TCB
Certification
Issued Under the Authority of the
Federal Communications Commission
By:

Timco Engineering, Inc.
849 NW State Road 45
Newberry, FL 32669

Date of Grant: 05/08/2019

Application Dated: 05/08/2019

Form Athletica

1090 Homer Street Suite 200

Vancouver,
Canada

Attention: David Degraaf

NOT TRANSFERABLE

EQUIPMENT AUTHORIZATION is hereby issued to the named GRANTEE, and is VALID ONLY for the equipment identified hereon for use under the Commission's Rules and Regulations listed below.

FCC IDENTIFIER:	2ASL3-FSG100

Name of Grantee:	Form Athletica

Equipment Class:	Digital Transmission System
Notes:	Swimming goggles with heads-up display w/ Bluetooth Low Energy capability.

Grant Notes	FCC Rule Parts	Frequency Range (MHZ)	Output Watts	Frequency Tolerance	Emission Designator
	15C	2402.0 - 2480.0	0.00328

Power listed is conducted.

COPY	FEDERAL COMMUNICATIONS COMMISSION WASHINGTON, D.C. 20554 GRANT OF EQUIPMENT AUTHORIZATION	COPY
Certification

Form Athletica
1090 Homer Street Suite 200
Vancouver,
Canada