The Wireless Telegraphy (Licence Award) Regulations 2012

Regulation 4(3)(a)(i)

SCHEDULE 4 APPLICATION FORM AND WARRANTY

1.    Details of the applicant

Provide the following details for the applicant—

• Applicant’s full name

• Registered number of company

• Registered office of company

• Bank sort code and account number

• Name of individual contact within applicant

• Contact address (if different from registered office)

• Contact telephone number

• Contact mobile telephone number

• Contact fax number

• Contact electronic mail address

2.    Authorised persons

Provide details of the name and position in the applicant of at least three and no more than five persons, each of whom has authority to bind the applicant for all purposes relating to the award process. Also provide a specimen signature of each of these persons.

3.    Directors or members of managing body

Provide the name and job title of each of the directors of the applicant or each of the members of the managing body of the applicant.

4.    Applicant group

Provide the names of all other members of the applicant group (as defined in the Regulations) in respect of which the applicant has completed a document in the form set out in Schedule 5 to the Regulations in accordance with regulation 4(3)(a)(ii) of the Regulations.

5.    Qualification to bid

In relation to the determination by the Office of Communications (“OFCOM”) under regulation 9 of the Regulations—

(a) provide details of any reason why the applicant may not be a fit and proper person to hold a licence;

(b) state whether any member of the applicant’s applicant group has colluded, or attempted to collude, or is colluding or attempting to collude, with another person to distort the outcome of the award process and provide a description of any such collusion;

(c) state whether any member of the applicant’s applicant group has acted or is acting in a way which is likely to distort the outcome of the award process and provide a description of any such actions;

(d) state whether any member of the applicant’s applicant group, or any person to whom confidential information has been disclosed, has disclosed confidential information, whether directly or indirectly, to any person, and provide a description of the circumstances of any disclosure and the information disclosed, except where the disclosure—

(i) was to a member of the applicant’s applicant group; or

(ii) was to OFCOM;

(e) state whether any member of the applicant’s applicant group has obtained or is obtaining or attempting to obtain confidential information relating to another applicant and provide a description of any such circumstances;

(f) state whether any member of the applicant’s applicant group is receiving or is attempting to receive services in relation to the award process from any person who has provided or is providing services to OFCOM in relation to the award process and provide a description of the services concerned; and

(g) state whether (and provide a description of any circumstances in which) any person who is a member or a director or employee of a member of the applicant’s applicant group and also a director or employee of a member of another applicant group is—

(i) taking part in the preparation of both applicant groups for participation in the award process; or

(ii) receiving confidential information relating to both applicant groups.

6.    Other information

Provide a brief description of the substance of—

(a) agreements (if any) relating to the management of the applicant; and

(b) any criminal investigations or proceedings in the United Kingdom or overseas of which the applicant is aware relating to the applicant or any member of its applicant group or its directors or officers.

7.    Existing spectrum holdings

Confirm that the applicant has provided the details of existing spectrum holdings required under regulation 4(3)(a)(iii) of the Regulations.

8.    Warranty

Provide the following warranty—

“[Insert name of applicant] (the “applicant”) represents and warrants to the Office of Communications that—

(a)

the persons authorised in section 2 of this application have read and understood the Regulations, the terms of the licence to be granted under the Regulations, and the Wireless Telegraphy Act 2006;

(b)

the applicant has the legal authority to participate in the award process under the Regulations and to have a licence granted to it, and has in place all necessary consents, permissions and internal approvals for this purpose;

(c)

the information provided in, or in support of, the application (including the details of existing spectrum holdings provided in accordance with regulation 4(3)(a)(iii) of the Regulations) is, to the best of the knowledge and belief of the applicant true, accurate and complete in all material respects; and

(d)

the applicant is aware of the provisions in regulations 112 and 114 of the Regulations, including the provisions about disclosure of confidential information (as defined in the Regulations) and obtaining confidential information relating to another applicant or bidder and that any such activities may lead to forfeiture of sums on deposit and exclusion from the award process.