Form FCC Form 214 FCC Form 214 International Section 214 Application

Approved by OMB
3060-0686

INTERNATIONAL SECTION 214 APPLICATION
FCC FORM 214
FOR OFFICIAL USE ONLY
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APPLICANT INFORMATION
Note: Use only standard punctuation. Please do not use special characters - such as ';' - in any of the
fields below!
Enter a description of this application to identify it on the main menu:
1. Applicant

DBA
Name:

Phone
Number:
Fax
Number:

Street:

E-Mail:

City:

State:

Country:

Zipcode:

Name:

-

Attention:
2. Contact
Name:

Phone
Number:

Company:

Fax Number:

Street:

E-Mail:

City:

State:

Country:

Zipcode:

Attention:

Relationship:

3. Place of Incorporation of Applicant
4. Other Company(ies) and Place(s) of Incorporation

-

5. Service Type(s) (check all that apply)
Global or Limited Global Facilities-Based Authority (Section 63.18(e)(1))
Global or Limited Global Resale Authority (Section 63.18(e)(2))
Individual Facilities-Based Service (Section 63.18(e)(3))
Individual Switched Resale Service (Section 63.18(e)(3))
Individual Facilities-Based and Resale Service (Section 63.18(e)(3))
Switched Services over Private Lines (ISR) (Section 63.16 and/or 63.18 (e)(3))
Inmarsat and Mobile Satellite Service (Section 63.18(e)(3))
Overseas Cable Construction (Section 63.18(e)(3))
Individual Non-Interconnected Private Line Resale Service (Section 63.18(e)(3))
Other (Section 63.18(e)(3))
6a. Is a fee submitted with this application?
If Yes, complete and attach FCC Form 159.
If No, indicate reason for fee exemption (see 47 C.F.R.Section 1.1114).
Governmental Entity
Noncommercial educational licensee
Other(please explain):
6b. Fee Classification
7. Destination Country(ies) (e.g., "Country X", "All international points", "All international points except Country X and Country
Y" or "Countries X, Y, and Z only".)
8. Caption (description of authority requested, e.g., Application for Authority to Provide International Facilities-Based and
Resold Services to All International Points Except Country X)

9. Does the applicant request streamlined processing pursuant to 47 C.F.R. Section 63.12? If yes,
include in Attachment 1 a statement of how the application qualifies for streamlined processing.

Yes

No

10. If applying for authority to provide switched services over private lines pursuant to Section 63.16, provide the required
showing in Attachment 1.

Applicant certifies that its responses to questions 11 through 17 are true:
11. If the applicant is a foreign carrier, or is affiliated (as defined in 47 C.F.R. Section 63.09(e)) with a foreign carrier, provide in
Attachment 1 the information and certifications required by Section 63.18(i) through (m).
12. Does the applicant seek authority to provide service to any destination described in paragraphs (1)
through (4) of Section 63.18(j)? If yes, list those destinations in Attachment 1 as a response to question
12.

Yes

No

13. Does the applicant seek authority to provide service to any destinations other than those listed in
response to question 12 where it has an affiliation with a foreign carrier? If yes, list those destinations
in Attachment 1 as a response to question 13.

Yes

No

14. [Section 63.18(h)] In Attachment 2, provide the name, address, citizenship and principal business of the applicant's ten
percent or greater direct and indirect shareholders or other equity holders, and identify any interlocking directorates.
15. In Attachment 2, respond to paragraphs (d), (e)(3) and (g) of Section 63.18.
16. By checking Yes, the undersigned certifies that neither applicant nor any other party to the
application is subject to a denial of Federal benefits that includes FCC benefits pursuant to Section
5301 of the Anti-Drug Act of 1988, 21 U.S.C. Section 862, because of a conviction for possession or
distribution of a controlled substance. See 47 CFR 1.2002(b) for the meaning of "party to the
application" for these purposes.

Yes

No

17. By checking Yes, the applicant certifies that it has not agreed to accept special concessions directly
or indirectly from a foreign carrier with respect to any U.S. international route where the foreign
carrier possesses sufficient market power on the foreign end of the route to affect competition
adversely in the U.S. market and will not enter into such agreements in the future.

Yes

No

CERTIFICATION
18. Typed Name of Person Signing (Must be a Corporate Officer)

19. Title of Person Signing

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND / OR
IMPRISONMENT
(U.S. Code, Title 18, Section 1001), AND/OR REVOCATION OF ANY STATION AUTHORIZATION
(U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).
20. 1:

Attachment

2:

Attachment

3:

Attachment

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT
The public reporting for this collection of information is estimated to average 9 hours per response, including
the time for reviewing instructions, searching existing data sources, gathering and maintaining the required
data, and completing and reviewing the collection of information. If you have any comments on this burden
estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Federal
Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-0686), Washington, DC
20554. We will also accept your comments regarding the Paperwork Reduction Act aspects of this collection
via the Internet if you send them to PRA@fcc.gov. PLEASE DO NOT SEND YOUR RESPONSE TO THIS
ADDRESS.
Remember - You are not required to respond to a collection of information sponsored by the Federal
government, and the government may not conduct or sponsor this collection, unless it displays a currently valid
OMB control number or if we fail to provide you with this notice. This collection has been assigned an OMB
control number of 3060-0686.
THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995,
PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.
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11/6/2014