Schedule 4
APPLICATION FOR A SUBMARINE CABLE LICENCE
(Regulation 6 (2))
Name of Applicant_________________________________
Type of Application New Application
Application to Modify/Amend and Existing Licence
Application to Renew Licence
National Telecommunications Regulatory Commission
[Insert Address]
[ECTEL Member State]
Guidance Notes
• Please note that this form may also be used for an application to modify an existing licence under section 39 of the Telecommunications Act, Cap. 8.11.
• [3] copies of the completed application form should be submitted in an envelope clearly marked “Telecommunications Submarine Cable Licence Application” addressed to Secretary, National Telecommunications Regulatory Commission, [Insert Address], [ECTEL Member State].
• For a renewal of licence please attach a copy of the present or existing licence to the completed application form
• The completed application form must be accompanied by a fee of one thousand Eastern Caribbean dollars (EC$1000) for each licensable service, payable to the National Telecommunications Regulatory Commission, [ECTEL Member State].
• For questions or sections which are not applicable, write or type “NOT APPLICABLE” in bold or print.
• Incomplete applications or applications with conditional statements may be summarily rejected
• Please indicate which, if any, information provided by the applicant in this application is to be considered confidential.
• Please note that any word, phrase or expression used herein shall have the same meaning as it has in the Telecommunications Act, Cap 8.11.
• The contents of this application form do not constitute legal advice. Applicants are urged to seek independent confirmation and professional advice with respect to any matter pertaining to the telecommunications licensing regime.
1. Part I - THE APPLICANT
(Please complete fully in type or block letters)
1.1 Contact Details
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1.1.1 Name and business address of applicant
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1.1.2 Postal address (if different from above)
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1.1.3 Designated contact person
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1.1.4 Telephone number
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1.1.5 Fax number
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1.1.6 E-mail address (if available)
1.2. Business Details
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1.2.1 If the applicant is a company, partnership, or other body corporate please give the name(s) and private address of each of the current directors, company secretary, or partners:
Name Address
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______________________________________________
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______________________________________________
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______________________________________________
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______________________________________________
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1.2.2 State the name under which applicant proposes to trade, and registered office address if different to above:
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______________________________________________
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______________________________________________
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______________________________________________
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______________________________________________
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______________________________________________
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______________________________________________
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1.2.3 In the case of a company or other body corporate, please provide copies of the company's/entity's articles of incorporation.
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1.2.4 Address in [ECTEL Member State] for service of process or other notices (in case of overseas applicant)2
1.3 History of the Applicant
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1.3.1 Has the applicant ever applied for a Licence or registration under any Act in [ECTEL Member State] and been refused?
[YES] [NO]
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______________________________________________
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______________________________________________
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1.3.2 Has the applicant ever been licensed under the Telecommunications Act, Cap. 8.11?
[YES] [NO]
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______________________________________________
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______________________________________________
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1.3.3 If the answer to question 1.3.2 is YES, has any such licence been revoked?
[YES] [NO]
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______________________________________________
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______________________________________________
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1.3.4 Has any Affiliate of the applicant previously been granted a licence under the Telecommunications Act, Cap. 8.11 which was revoked?
[YES] [NO]
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______________________________________________
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______________________________________________
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1.3.5 Is the applicant the holder of a telecommunications licence in any other country?
[YES] [NO]
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______________________________________________
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______________________________________________
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1.3.6 Has the applicant or any Affiliate been refused a Licence mentioned in question 1.3.5 above, or had a Licence revoked?
[YES] [NO]
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______________________________________________
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______________________________________________
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1.3.7 Has the applicant operated under or carried on business under any name other than the name in this application?
[YES] [NO]
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______________________________________________
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______________________________________________
2 PART II - APPLICANT'S BUSINESS AND PROPOSED NETWORK AND/OR SERVICE(S)
2.1 Financial Information and Business Plan
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2.1.1 Please provide a business plan. The plan should outline any major assumptions used and should cover a period of at least [five] years. The information provided should include:
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(a) Sources of funding, debt levels, equity and independent confirmation as appropriate;
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(b) Financial statements/projections for [five] years to include cash flow and income statements; and
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(c) Market forecasts.
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2.1.2 For a going concern please provide Audited Financial Reports including certified Income Statements and Balance Sheets for the last three years in respect of the Company on whose behalf the application is being submitted.
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2.1.3 Please provide a diagrammatic representation of the applicant's group structure, including the percentage of shares held. Please indicate which affiliates have, or intend to apply for, other telecommunications licence.
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2.1.4 Does the applicant have any shareholdings of over 5% in any other licensed telecommunications provider in the OECS?
[YES] [NO]
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______________________________________________
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______________________________________________
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2.1.5 Does the applicant have any other trading activities in or outside the telecommunications market?
[YES] [NO]
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______________________________________________
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______________________________________________
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If the answer is YES, please provide details of any arrangements made to ensure no cross-subsidization between the applicants:
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(a) telecommunications and non-telecommunications activities
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(b) wholesale and retail activities
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(c) telecommunications equipment production or supply and other telecommunications activities.
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2.1.6 Please provide brief résumés of key managerial staff, indicating relevant prior experience, qualifications and other sources of expertise as appropriate, and also explain what technical resources exist to help complete plans.
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2.1.7 Has any member of the applicant's managerial staff been bankrupt, or been a director of a company which has become insolvent?
[YES] [NO]
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______________________________________________
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______________________________________________
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If the answer is YES, please attach a certified copy of the discharge.
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2.1.8 Has the applicant or any member of the applicant's managerial staff ever been the defendant or respondent in any proceedings in any court in any jurisdiction involving dishonesty, fraud, theft or violence, or is the applicant or any member of the applicant's managerial staff currently the subject of a charge or indictment under the law of any country for [contravention of any law or for] any conduct involving dishonesty, fraud, theft or violence?
[YES] [NO]
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______________________________________________
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______________________________________________
3 PART III Technical Information
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3.1 Please provide information on:
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(a) the intended route of the cable and in the case of a terminating cable the landing points of the cable in [Contracting State]
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______________________________________________
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______________________________________________
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(b) the technical description of each proposed cable network, including details on the following:
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(i) all technical aspects of the cable, including type, capacity and accessory equipment;
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(ii) cable route with proposed landing point(s);
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(iii) how access to the cable is to be provided (e.g. indirect access, direct access, leased lines, etc.);
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(iv) support mechanisms for the cable landing and maintenance;
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(iv) targeted customer base, including type and number of customers targeted.
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______________________________________________
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______________________________________________
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(c) documentation indicating compliance with the requirements of the Ministry of Planning (or its equivalent)
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______________________________________________
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______________________________________________
4. PART IV - DECLARATION
On behalf of the applicant, I declare that the information provided by me on behalf of the applicant is accurate and complete in all respects.
Signed:
_________________________________________
Full name of signatory: Post held:
_________________________________________
Date:
_________________________________
2___________________
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(i) in the case of an individual, by the person in whose name the application is made;
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(ii) in the case of a sole proprietorship, by the sole proprietor, or
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(iii) in the case of a partnership, by a partner; or
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(iv) in the case of a company or other body corporate, by a director of the company or other body corporate