The present document provides the Protocol Implementation Conformance Statement (PICS) proforma for conformance test specifications for the IPv6 transition technology DS-Lite as defined in ETSI TS 101 569-1 [1] in compliance with the relevant requirements and in accordance with the relevant guidance given in ISO/IEC 9646-7 [3]. A supplier of an implementation which is claimed to conform to ETSI TS 101 569-1 [1] is required to complete a copy of the PICS proforma provided in the annex A of present document.