CPC-2-1-23- Licensing Procedure for Spectrum Licences for Terrestrial Services - Spectrum Management and Telecommunications

Spectrum Management and Telecommunications

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Appendix D - Sample Application for a Subordinate Licence

Part 1 Information to Be Completed by Existing Licensee (Primary Licensee)

1.1 Licensee Name: _____________________________________________

1.2 Address: ____________________________________________________
Street, P.O. Box, etc.

_________________________________
City, Town Province

________________________
Postal Code

_________________________________
Telephone Number Fax Number

________________________
Email Address

1.3 Licence Account Number: ___________________________________

1.4 Summary of Proposed Subordinate Licence(s):

Primary Licence #	Subordinate Licence Expiry Date*	Subordinate Licence Frequency Range (MHz)*	Subordinate Licence Geographic Area*

*Note: Not to exceed the authorization granted to the primary licence in any respect.

1.5 Map enclosed Yes____ No _____ (Required when subordinate licence area is smaller than the primary licence area.)

1.6 Proposed Issuance Date of Subordinate Licence(s): _____________

1.7 Authority

I certify that I am an authorized representative of the above-named licensee and that the information stated in Part 1 of this Notification is true and correct.

SIGNED this _____ day of __________________, in the year ________

________________________________________________________
Signature of Applicant or Individual Authorized to Sign for the Licensee

__________________________________________________________
Name of Applicant or Individual Authorized to Sign for the Licensee (Please print clearly)

__________________________________________________________
Title of Person

Part 2 Information to Be Completed by Proposed Subordinate Licensee

2.1 Name: ___________________________________________________

2.2 Address: _________________________________________________
Street, P.O. Box, etc.

_________________________________
City, Town Province

________________________
Postal Code

_________________________________
Telephone Number Fax Number

________________________
Email Address

2.3 Authority

I certify that I am an authorized representative of the above-named proposed subordinate licensee and that the information stated in Part 2 of this Notification is true and correct.

I certify that I have read and I understand the contents of the eligibility criteria as set out in the Radiocommunication Regulations and that I comply with these requirements. I will comply with the criteria on an ongoing basis and will notify the Minister of Industry of any change which would have a material effect on my eligibility. Such notification will be made in advance of any proposed transactions within my knowledge.

I certify that I understand the use to which the radio frequencies, that are the subject to the subordinate spectrum licence(s), may be employed.

I certify that I will comply with the conditions of licence that will apply to the subordinate spectrum licence(s).

I also understand that the Department may require additional information for the review of the proposed subordinate licence.

SIGNED this _____ day of __________________, in the year _______

___________________________________________________________
Signature of Applicant or Individual Authorized to Sign for the Subordinate Licensee

___________________________________________________________
Name of Applicant or Individual Authorized to Sign for the Subordinate Licensee (Please print clearly)

___________________________________________________________
Title of Person

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