Radiocommunications Licence Application Form

Radiocommunications Licence Application

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Instructions:
1. All sections of the form MUST be completed. Please write in BLOCK CAPITAL letters in Black or Blue ink.

2. For Sections A., B., C.1), C.2), E, F and G, you will be required to type in the necessary information or check off the necessary check boxes. The information required by Sections C.3), C.4) and D should be provided in separate attachments to this form, clearly labelled using the section numbers and headings contained in the Form.

3. Where the applicant submits this application in connection with an application for a concession to operate a public telecommunications network or to provide public telecommunications or broadcasting services, this Licence Application shall be appended to the Concession Application (Form C10) and the applicant need not reproduce in this application any information that is submitted in the concession application.

4. Throughout the application form, references are made to notes which can be found at the end of the form. Please ensure that you read these since they provide clarification or additional information on the various sections of the form.

5. The submission checklist in section F must be submitted, and the Declaration in section G must be signed by the Applicant or a duly authorised representative.

A. GENERAL INFORMATION
Applicant^.i


Contact Information:
Title:
First Name:
Last Name:
Position:
Mailing Address:
Street 1:
Street 2:
Town/City:
Telephone:
Fax:
Email:
B. BASIS OF APPLICATION:
Select One:
Ref:	^.ii

C. APPLICANT INFORMATION
C.1. Nature of Applicant:

Select One:
If other, please specify:

2) Registration Informationⁱⁱⁱ
Registered Name
Company Registration No:
Trinidad and Tobago Company Registration Number (if different):

Date of Registration:
Place of Incorporation:
Registered address
Street 1:
Street 2:
Town/City:
Trinidad and Tobago REgistered address (if different)
Street 1:
Street 2:
Town/City:
Trading or Business Names (if different from company name):

Company BIR Number:
Company VAT Registration Number:

3) Ownership and Management: i) Where the applicant is a company, provide the full names and addresses of all directors, identifying executive and non-executive directors. Where the applicant is a partnership, provide the full names and addresses of all partners ^iv

ii) Provide details of any criminal record or personal bankruptcy of the Applicant, or of any person listed in (a).

iii) Where the applicant is a company, provide the names of all shareholders of the company, and their percentage shareholding. If the applicant is a public company, identify only shareholders owning more than 5% of the outstanding allocated and registered shares.^v

iv) Provide a diagram of the ownership and corporate structure of the company, showing any parent, subsidiary or holding companies.^vi

4) Applicant's Busienss Information:^vii

i) Size of company or business (including number of staff, locations, etc)

ii) Principal business activities

iii) Financial statements for the three years preceding the application

D. Service Information

Provide an explanation of the applicant’s business activities relevant to this application, and how the radio-transmitting equipment or radiocommunications services that are the subject of this application relate to those business activities (use additional sheet if necessary):

E. TECHNICAL SPECIFICATION FORMS

Quantity

Form

Description

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TS-PP

Point-to-Point Radiocommunications System

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TS-PM

Point-to-Multipoint Radiocommunications System

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TS-LM

Land Mobile Radiocommunications System

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Add

TS-SS

Satellite Earth Station Radiocommunications System

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TS-MA

Maritime Radiocommunications System

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TS-CS

Coast Station Radiocommunications System

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TS-AE

Aeronautical Radiocommunications System

F. SUBMISSION CHECKLIST
Please ensure that the relevant documents for the following have been submitted:
ITEM SECTION	DESCRIPTION	DOCUMENT SUBMITTED	CHECK BOX IF NOT APPLICABLE
Form L1	Completed and Signed Licence Application (L1) Form
C 2	Copy of Certificate of Incorporation		NA
C 2	Copy of Certificate of Trinidad and Tobago Registration		NA
C 3	Directors’/Partners’ Information		NA
C 3	Shareholders’ Information		NA
C 3	Ownership/Structure Diagram		NA
C 4	Financial Statements		NA
F	ALL Required Technical Specification Forms

G. DECLARATION AND SIGNATURE

I, the undersigned, do hereby declare on my own behalf and on behalf of the Applicant(s) that the information provided in this application is correct and accurate to the best of my knowledge. I acknowledge and agree that submitting an application to the Telecommunications Authority of Trinidad and Tobago does not mean that a licence will be granted, and that consideration of this application is a matter for the exercise of the Authority’s discretion acting in accordance with the Telecommunications Act, 2001. If the licence is granted, I am fully aware of all the obligations and conditions associated with the licence. I understand that in processing this application, the Authority may undertake such investigations as it considers appropriate to verify the information submitted and/or to assess the background or suitability of any person involved or to be involved in any permission or authorisation hereby applied for, and I hereby expressly consent for myself and on behalf of the applicant(s) and all such persons, to the carrying out by the Authority of such investigations. I confirm that I am duly authorised by all the relevant persons to make this declaration.

Applicant

Name of individual authorised to sign on behalf of company

Title:

First Name:

Last Name:

Title:

Signature:

Date:

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ⁱ Where the applicant is a company, use its full Registered Name as stated on the Certificate of Incorporation.
ⁱⁱ Insert TATT reference number of all existing licences to be amended.
ⁱⁱⁱ Not applcable to individual applicants, unless the radoitransmitting equipment or radiocommunications service is to be used in respect of the operations of a business as a sole trader.
^iv Not applicable to individual or sole trader.
^v Not applicable to individual or sole trader.
^vi Not applicable to individual or sole trader.
^vii Not applicable if the radoitransmitting equipment or radiocommunications service is to be used by an individual in his or her private capacity, and not in relation to a business.
^viii Not applicable if the radoitransmitting equipment or radiocommunications service is to be used by an individual in his or her private capacity, and not in relation to a business.