Electronic Communications Act, 2005 (Act No. 36 of 2005)

Regulations

Licensing Processes and Procedures Regulations, 2010

Forms

Form C : Application to amend an Individual licence
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Form C

 

Application to amend an Individual Licence

(Regulation 9)

 

Independent Communications Authority of South Africa

 

Note:

(a)Applicants must refer to the Electronic Communications Act, 2005 (Act No. 36 of 2005) ("the Act") and any regulations published under that Act with regard to the requirements to be fulfilled by applicants.
(b)Information required in terms of this Form which does not fit into the space provided may be included in an appendix attached to the Form. Each appendix must be numbered with reference to the relevant part of the Form.
(c)Where any information in this Form does not apply to the applicant, the applicant must indicate that the relevant information is not applicable.

 

1.PARTICULARS OF LICENCE
1.1Licence number:
1.2Nature of services authorised to be provided in terms of the Licence:
1.3Attach a copy of the Licence that is the subject of this application. The copy of the Licence must be marked clearly as Appendix 1.3 of FORM C.

 

2.PARTICULARS OF APPLICANT (LICENSEE)
2.1Full name of applicant:

 

 
2.2Designated Contact person:

 

 
2.3Applicant's street address:

 

 
2.4Applicant's principal place of business (if different from street address);

 

 
2.5Applicant's postal address:

 

 

 

2.6Applicant's Telephone number/s:

 
2.7Applicant's mobile number/s:

 
2.8Applicant's telefax number/s:

 
2.9E-mail address of designated contact person:

 

 

3.PROPOSED AMENDMENT TO THE LICENCE
3.1Set out the proposed amendment/s.

 

 

 
3.2Set out the reasons for the proposed amendment/s to the Licence. If the amendment is with regard to programming, please attach a research undertaken supporting the proposed amendment.

 

 

 
3.3Explain the implications (if any) of the proposed amendment/s, with specific reference inter alia to the provisions of section 10(1)(a), (b), (c), (d) and (f) of the Act:

 

 

 

 

4.RADIO FREQUENCY SPECTRUM
4.1Indicate whether the applicant holds a radio frequency spectrum Licence. If so, provide details thereof and attach a copy of the radio frequency spectrum Licence marked clearly as Appendix 4.1 of FORM C:

 

 

 
4.2In the event that an amendment to the applicant's radio frequency spectrum Licence is necessary, provide details of such an amendment. A separate application to amend the applicant's radio frequency spectrum Licence must be submitted to the Authority in this regard at the same time as this application.

 

5.UNDERTAKINGS
5.1Provide details of undertakings (if any) and other matters which, in the applicant's view, the Authority may need to take into consideration:

 

 

 
5.2Attach a resolution authorising the person(s) not more than two (2) signing this application. The person(s) must liaise with the Authority during the registration process. The resolution must be marked clearly as Appendix 5.2 of FORM C.

 

The person signing the application on behalf of the applicant must acknowledge as follows:

 

I acknowledge that the Authority reserves the right to have any Licence amended pursuant to this application set aside, should any material statement made herein, at any time, be found to be false.

 

 

Signed ..........................................................................

(APPLICANT)

 

I certify that this declaration was signed and sworn to before me at ..................................... on the ............... day of ............................... 20 ..... , by the deponent who acknowledged that he/she:

1.knows and understands the contents hereof;
2.has no objection to taking the prescribed oath or affirmation; and
3.considers this oath or affirmation to be truthful and binding on his/her conscience.

 

 

                                                                   

COMMISSIONER OF OATHS

 

Name:

 

Address:

 

Capacity:

 

[Form C substituted by regulation 7 of Notice 154 of 2016, GG 39871, dated 30 March 2016]