Telecommunication Act – 2001

(Act 2001-36)

FORM 6

TU006

APPLICATION FOR TELECOMMUNICATIONS

NETWORK LICENCE

IMPORTANT INFORMATION

1. Application Guidelines and the information to be provided along with the application are attached to this form.

2. Applicant is required to meet the Ministry’s minimum requirement for assignment of radio frequency.

3. Please forward cheque by mail to the address given below.

4. Where supporting documents are required, applicant is required to send the document by mail to the following address:

The Telecommunications Unit

Ministry responsible for Telecommunications

The Business Centre

Upton, St. Michael

NOTES

1. This Application Form must be completed in its entirety and submitted to the Ministry with the prescribed application fee in accordance with the instructions below.

2. The Minister may request the applicant to provide additional information not contained in this application form.

3. Applicants are responsible for complying with the application procedures and requirements set forth in the Telecommunications (Public Telecommunications) (Licensing) Regulations, 2003 issued by the Minister.

4. Applicants are responsible for complying with other Government requirements regarding construction and use of the proposed network facilities (e.g. Town and Country Planning legislation).

5. To be eligible for filing an application, applicant must comply with all legal requirements for holding a licence.

6. Applicants providing false or misleading information will be subject to penalties in accordance with section 92 of the Telecommunications Act 2001-36.

7. A brief description of the proposed network, but not the submitted application, will be made available for public inspection. Information provided in this application will be treated as confidential.

8. Grant of licence is at the discretion of the Minister. Application fees are not refundable.

9. This application is only for a licence to construct, operate, and maintain a telecommunications network. A separate application and licence is required for use of spectrum. The applicant must have both licenses before the applicant can operate the network or use the spectrum required to operate the proposed telecommunications network. The applicant is urged to submit this application and the application for a Spectrum Licence at the same time to expedite the processing. The application form for a Spectrum Licence may be obtained from the Ministry.

10. Any person seeking to provide telecommunications service in Barbados must submit a separate application for a Service Provider Licence. This application form may be obtained from the Ministry.

11. Persons operating without the required licences are subject to the fines and penalties set out in the Telecommunications Act 2001-36.

12. Applicants granted a licence by the Minister will be responsible for paying an annual licence fee in accordance with the Telecommunications (Licence Fees) Regulations, 2003.

13. This form may be used also to modify a pending application for a telecommunications network or for an application to modify an existing Telecommunications Network Carrier Licence. In such cases, the Ministry should be consulted to determine the appropriate modification fee to be submitted.

General Filing Instructions

1. If this is a request for modification for an application pending or modification of a licence, applicant must consult the Ministry for the appropriate modification fee.

2. To be accepted for filing, applications must be signed by a person authorised by the applicant. By signing, the applicant certifies that the information submitted is true, complete, correct, and made in good faith.

3. The applicant shall submit 2 copies of the application, including supporting documentation, and the application fee, to:

The Chief Telecommunications Officer

Telecommunications Unit

Ministry responsible for Telecommunications

Barbados

Instructions for Completion

If this is an application to modify an application, please attach a copy of the original application submitted, and, if requesting a licence modification, also attach the licence granted. Where there is no change in the information requested in the application form, please put “No Change’ next to the information requested. Where the information requested is not the same, please indicate the modification being proposed and the nature of the change and the reason for the proposed change.

Part A: Applicant Information

Items 6 – 12: Contact information should be provided for the person the applicant has designated as the person to whom the Ministry should send correspondence.

Items 13 –23: All relevant information may please be given in full.

Part B: Technical Information

Items 24 – 37: All columns be correctly filled up and answered. Also briefly describe the proposed network, the types of services, support, and whether analogue or digital. Please note any unique features.

Part C: Self Explanatory

Part D: Self Explanatory

PART A: APPLICANT INFORMATION

1. Name (if individual)

First Name

Last Name

2. Nationality

3. Address of Applicant (registered office or principal place of business):

Street Address

City

State

Zip

4. Mailing Address (if different from registered office):

Street Address

City

State

Zip

5. Applicant is a(n):

Individual

Corporation

Unincorporated Association

Partnership

Please indicate whether this is:

A new application

An application to modify an existing licence

Renewal of existing licence

6. Telephone No.

7. Facsimile No

8. Email address

9. Name of Manager of entity

10. Person in Barbados to be contacted in absence of Manager:

Name

First Name

Last Name

Address

Street Address

City

State

Zip

Telephone No.

Email address

11. Facsimile No:

12. Mobile No:

13. Indicate

(a) the approximate number of persons currently or to be employed by applicant

(b) the number of persons you expect to hire within the next year specific to the proposed network

14. Correspondence Address

Street Address

City

State

Zip

15. Pager/Cellphone Number

16. Is Application submitted with cheque?

Yes

17. Equipment Purchased From

18. Name of Seller & Dealer

19. Sellers & Dealer’s Licence No.

20. Dealer’s Address

21. Dealer’s Contact Person

22. Dealer’s Telephone Number

23. Application Information

Application Date

Month

Day

Year

Client’s Reference

System Description

Proposed use of System

Type of Licence (Please tick One)

- Localised Private Network

- Wide-Area Private Network

- Fixed Wireless Network

- Station (Spectrum) (Use separate form)

- Network (Spectrum) (Use separate form)

PART B: TECHNICAL INFORMATION

LAND FIXED STATION

24. Station 1 Information

Call-sign

Location

Station Address

Latitude in Degrees-Hours-Minutes (N/S) (e.g. 120-45-30 E)

Longitude in Degrees-Hours-Minutes (E/W) (e.g. 120-45-30 E)

Building Heights (metres)

Antenna Structure Height (metres)

Elevation (metres above mean sea level)

Transportable

Yes

Radius of Operation (Km)

25. Station 2 Information

Call-sign

Location

Station Address

Latitude in Degrees-Hours- Minutes (N/S) (e.g. 120-45-30 E)

Longitude in Degrees-Hours-Minutes (E/W) (e.g. 120-45-30 E)

Building Heights (metres)

Antenna Structure Height (metres)

Elevation (metres above mean sea level)

Transportable

Yes

Radius of Operation (Km)

26. Station 3 Information

Call-sign

Location

Station Address

Latitude in Degrees-Hours-Minutes (N/S) (e.g. 120-45-30 E)

Longitude in Degrees-Hours- Minutes (E/W) (e.g. 120-45-30 E)

Building Heights (metres)

Antenna Structure Height (metres)

Elevation (metres above mean sea level)

Transportable

Yes

Radius of Operation (Km)

27. Station 4 Information

Call-sign

Location

Station Address

Latitude in Degrees-Hours-Minutes (N/S) (e.g. 120-45-30 E)

Longitude in Degrees-Hours- Minutes (E/W) (e.g. 120-45-30 E)

Building Heights (metres)

Antenna Structure Height (metres)

Elevation (metres above mean sea level)

Transportable

Yes

Radius of Operation (Km)

28. Frequency Information

Station Name

Usage Period - Receive

Start Time

Stop Time

Usage Period - Transmit

Start Time

Stop Time

Desired Frequency

Start Time

Stop Time

Feeder Line Type

Start Time

Stop Time

Feeder Line Length (metres)

Start Time

Stop Time

Feeder Line Loss (dB)

Start Time

Stop Time

Bandwidth (KHz)

Start Time

Stop Time

Emission

Start Time

Stop time

29. Coverage/Link Information

Coverage Area - Centre Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30N)

Coverage Area - Centre Longitude in Degrees-Hours-Minutes (E/W) (eg. 120-45-30E)

Coverage Area - Radius (Kms)

Coverage Area - Link Location

30. Link to Station

Main Link

Call-Sign

Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30 N)

Longitude in Degrees-Hours-Minutes (E/W) (120-45-30E)

Aux Link 1

Call-Sign

Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30 N)

Longitude in Degrees-Hours-Minutes (E/W) (eg. 120-45-30 E)

Aux Link 2

Call-Sign

Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30 N)

Longitude in Degrees-Hours-Minutes (E/W) (eg. 120-45-30 E)

Aux Link 3

Call-Sign

Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30 N)

Longitude in Degrees-Hours-Minutes (E/W) (eg. 120-45-30 E)

31. Link to Geographical Point

Main Link

Call-Sign

Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30 N)

Longitude in Degrees-Hours-Minutes (E/W) (eg. 120-45-30 E)

32. Radio Equipment Information

Station Name

Manufacturer

Transmitter

Receiver

Model

Serial No.

Transmitter Power (watts)

33. Antenna Information

Manufacturer

Model

Antenna Displacement from Station Location

North Latitude Displacement (m)

East Longitude Displacement (m)

Effective Height (m)

Height Above Ground Level (m)

Gain (db)

Elevation Angle (degrees)

34. Filter Information

Manufacturer

Model

Insertion Loss (dB)

Tuned Frequency (MHz)

Manufacturer

Insertion Loss (dB)

Tuned Frequency (MHz)

35. Mobile or Portable Station Information

Station Information

Number of Mobiles

Mobiles Communihcate With

Number of Portables

Mobiles Communihcate With

Coverage Information

Centre of Coverage Area

Latitude in Degrees-Hours-Minutes (N/S) (eg. 120-45-30 N)

Longitude in Degrees-Hours-Minutes (E/W) (eg. 120-45-30 E)

Radius (km)

36. Mobile Vehicle or Vessel Registration Nos.

Manufacturer

Model

Serial No.

Mobile Vehicle or Vessel Registration Nos.

Manufacturer

Model

Serial No.

Mobile Vehicle or Vessel Registration Nos.

Manufacturer

Model

Serial No.

Mobile Vehicle or Vessel Registration Nos.

Manufacturer

Model

Serial No.

Mobile Vehicle or Vessel Registration Nos.

Manufacturer

Model

Serial No.

Portables

Manufacturer

Model

Serial No.

Portables

Manufacturer

Model

Serial No.

Portables

Manufacturer

Model

Serial No.

37. Frequency Information

Desired Frequency

Transmit

Receive

Bandwidth

Transmit

Receive

Emission

Transmit

Receive

PART C: DOCUMENTATION INFORMATION

The applicant must provide the following documents:-

(a) Copy of the certificate of incoporation or business registration certificate.

(b) Most recent annual audited financial report.

(d) Performance Bond or Bank Guarantee for payment of licence fees for the first two years of the licence.

PART D: CERTIFICATION AND SIGNATURES

We declare that we have not commenced provision or operation of any of the telecommunications stations or networks applied for in this application and all the information in this application form is true and correct. We understand that approval from the Ministry for this application is based on information as declared in this application. We further acknowledge that, should any of the information declared herein be found to be untrue, inaccurate or incorrect, any licence granted by the Ministry will be rendered null and void. The Ministry reserves its right to impose penal sanctions against us under any applicable laws and regulations in force and this is without prejudice to any civil remedies that the Ministry has against us if any of the information declared in the application be found to be untrue, inaccurate or incorrect.

Signature

First Name

Last Name

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Name

First Name

Last Name

Date

Month

Day

Year

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