Use of “x” represents a request for field to be a Variable
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Firmware Version Number:
Application Version Number:
(if applicable)
Designed for deployment only in controlled environments as defined in ISO 13491-2?
Yes
No
At the end of this form under “Device Specification Sheet,” attach documentation highlighting device characteristics, including photos. These photos are to include both external and internal pictures of the device. The internal pictures are to be sufficient to show the various components of the device.
AHardware Version Number – Request for Use of the Variable “x”
Note: The firmware version number may also be subject to the use of variables in a manner consistent with hardware version numbers. See the PCI PTS Device Testing and Approval Program Guide for more information.