This document provides a reliability qualification test template for dynamic modules (DMs). The template describes the reliability qualification test items and provides information on requirements or options. Example test conditions are given as information in Annex A. For reliability qualification purposes, some information about the internal components, parts and interconnections is needed. These internal parts are treated as black boxes. This document gives requirements for the evaluation of DM reliability by combining the reliability of such internal black boxes. The object of this reliability qualification test template is to provide a framework for the reliability qualification tests for DMs. Developers of reliability qualification tests for DMs determine the test conditions for each test item by referring to the examples in Annex A.