[Government of Barbados] Application for Private Trunked Radio-Communication Network Licence

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Telecommunication Act

(Act 2001-36)

FORM 23

IMPORTANT INFORMATION (Please read the following information before completion)

1. Payment of licence fees may be made by cash or cheque.

2. Where supporting documents are required, applicant is required to send documents by mail to:

Telecommunications Unit

Ministry responsible for Telecommunications

Warrens Complex

Warrens,

St. James

Telephone No. 246-430-2251

Fax No: 246-426-0960

APPLICATION FOR PRIVATE TRUNKED RADIOCOMMUNICATION NETWORK LICENCE PART A: APPLICANT INFORMATION

(Please read the Notes provided at the front of this Form before completion)

2. Nationality (if individual)

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

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

5. Applicant is a (n):

Individual

Corporation

Unincorporate Association

Partnership

Please indicate whether this is:

a new application

an application to modify an existing licence

an application to renew a licence

6. Telephone No:

7. Facsimile No:

8. "E-mail" address

Address:

Telephone No:

"E-mail" Address:

11. Facsimile No:

12. Mobile No:

Billing Address (if it is different from Mailing Address)

Pager / Cell Phone Number:

Is Application Submitted with Cheque?

Yes

2. General Information

System Description

Proposed Use of System

3. Station 1 Information

Station Name (cross-reference with Pages 4 & 5)

Location

Station Address

Latitude in Degrees-Minute-Seconds (N/S) (e.g. 120-45-30 N)

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

Site Elevation (metres above mean sea level)

Building Heights (metres)

Antenna Structure Height (metres)

Transportable Radius of Operation (Km)

Yes

4. Station 2 Information

Station Name (cross-reference with Pages 4 & 5)

Location

Station Address

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

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

Site Elevation (metres above mean sea level)

Building Heights (metres)

Antenna Structure Height (metres)

Transportable Radius of Operation (Km)

Yes

5. Station 3 Information

Station Name (cross-reference with 4 & 5)

Location

Station Address

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

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

Site Elevation (metres above mean sea level)

Building Heights (metres)

Antenna Structure Height (metres)

Transportable Radius of Operation (Km)

Yes

6. Station 4 Information

Station Name (cross-reference with Pages 4 & 5)

Location

Station Address

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

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

Site Elevation (metres above mean sea level)

Building Heights (metres)

Antenna Structure Height (metres)

Transportable Radius of Operation (Km)

Yes

7. Frequency Information

Station Name (cross-reference with Pages 2 & 3)

Usage Period

Start Time (Transmit)

Stop Time (Receive)

Desired Frequency Range (MHz)

Desired Carrier Frequency (MHz)

Feeder Line Type

Feeder Line Length (metres)

Bandwidth (kHz)

Emission

Double Entry

Polarization (Linear, Circular, etc.)

Bit Error Rate (Digital Only)

Baseband Noise/Power ratio (dB) (Analogue Only)

Modulation Scheme e.g. QAM, PSK

Modulation Type (Digital/Analogue)

Multiplexing Method e.g. FDMA, TDMA

8. Link Information

Link to Station (cross-reference to Pages 2, 3 and 4)

Main Link

Station Link

Aux Link 1

Station Name

Aux Link 2

Station Name

Aux Link 3

Station Name

Link to Geographical Point

Main link

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

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

Link Location

9. Radio Equipment Information

Station Name (cross-reference to Pages 2 & 3)

Manufacturer

Transmitter

Receiver

Model

Transmitter

Receiver

Serial No.

Transmitter

Receiver

Frequency Range (MHz)

Transmitter

Receiver

Bit Rate (Mb/s) (Digital Only)

Transmitter

Receiver

No. of Voice Channels (Analogue only)

Transmitter

Receiver

Transmitter Rated Power (dBm)

Transmitter

Receiver

Frequency Stability (Hz)

Transmitter

Receiver

Reliability (%)

Transmitter

Receiver

Long Term C/I (dB)

Transmitter

Receiver

Short Term C/I (dB)

Transmitter

Receiver

Minimum Acceptable Rx Signal Level (dBm)

Transmitter

Receiver

10. Antenna Information

Manufacturer

Model

Antenna Type

Antenna Diameter (m)

Frequency Range (MHz)

Height Above Ground Level (m)

Gain (dB)

3dB Beamwidth (degrees)

Connector Branching Loss (dB)

Elevation Angle (degrees)

Antenna Displacement from Station Location

North Latitude

Displacement (m)

East Longitude

Displacement (m)

11. Filter Information

Manufacturer

Model

RF Filter Type (bandpass/reject)

Total Loss (dB)

12. Technical Documents to be submitted

Antenna Radiation Diagram (co-polar & cross-polar)

Transmitter Spectrum Mask or Diagram

Receiver Filter Mask or Diagram

We declare that we have not commenced provision or operation of any of the telecommunication stations/network applied for in this appliction and all the information in this appliction 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.

Name / Signature

First Name

Last Name

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