UL Information Gathering Form

UL Reference No:_____________________ (Quote / Order / Project / Service Request / File No.)

Applicant / Listee: This is the company that controls and is responsible for the file. It is the company
name and address that will appear in UL Online Directories.
Company Name IOT US1 LLC
Address 14524 SW 104TH COURT, MIAMI, FL 33176

Contact name ORESTES LIMA PEREZ

Contact phone 3054137406
Email Olima77@gmail.com
Default Contact Person for ORESTES LIMA PEREZ
receipt of UL Certification
Report, if not yet established
Contact Name ORESTES LIMA PEREZ
Email 3054137406

Listee: Add comments here if the company name and address that will appear in UL Online Directories
should be different from the Applicant’s name.

Manufacturers: If you have more manufacturing locations, please feel free to attach additional sheets. If
the Manufacturer and Applicant are the same company, please be sure to indicate such. [Please do not
leave this section blank.] When adding a secondary or alternate location, please provide a factory
identification marking for each manufacturer in your file. This may be any designation of your choosing as
long as it appears on the product and is unique to the manufacturer.

Manufacturer Name
[ ] Same as Applicant
Address

Contact name
Contact phone
Email
Unique factory ID
Default Contact Person for
receipt of UL Certification
Report, if not yet established
Contact Name
Email

Manufacturer Name
Address

Contact name
Contact phone
Email
Unique factory ID
Default Contact Person for
receipt of UL Certification
Report, if not yet established
Contact Name
Email