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Application to renew a broadcasting licence for an INDIVIDUAL cable distribution undertaking
OR
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| The Commission may return the application if it has not been duly completed or if the required technical documentation has not been filed with Industry Canada. The onus will be on the applicant to submit a clear application that provides all of the relevant information, identifies all regulatory issues raised in the application and provides supporting documentation. |
Canadian Radio-television and Telecommunications CommissionForm 136 - Application to renew a broadcasting licence for an INDIVIDUAL cable distribution undertaking
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| Specify licence type: | Regional ( ) | Individual ( ) | ||
| Type of undertaking: | Class 1 ( ) | Class 2 ( ) | Class 3 ( ) | |
| Location: (To be identified on the licence) |
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1.1 Identification of applicant/licensee Name: Address: Fax: E-mail: Contact person representing the applicant/licensee |
| 1.2 Appointment of agent I, _________________________, the applicant/licensee, hereby appoint _____________________ as my agent for and on my behalf and in my name to sign, file and complete (if necessary) an application with the Canadian Radio-television and Telecommunications Commission and to sign and file a reply with respect thereto and I do hereby ratify, confirm, and adopt as my own act, such application and all replies made thereto. Date: |
| 1.3 Declaration of the applicant/licensee or its appointed agent I, ___________________________________ SOLEMNLY DECLARE THAT: a) I am the ___________________________ (representative/appointed agent) of the applicant/licensee named in this Application Brief and as such have knowledge of all matters declared therein. b) The statements made in this application, or any document filed pursuant to any request for further information by the Commission, are (will be) to the best of my knowledge and belief true in all respects. c) The opinions and estimates given in this application, or any document filed pursuant to any request for further information by the Commission, are (will be) based on facts as known to me. d) I have examined the provisions of the Broadcasting Act and the broadcasting regulations relevant to this application. And I have signed Signature: Date: Witnessed by Signature: Name (Printed): Date: At: |
| 1.4 Location(s) where the application may be examined
Set out the applicant’s website address or, if the application is not posted on their website, the email address where an electronic copy of the application may be requested: Website: Email: |
| Respond to question 1.5 if already operating the authorized cable distribution undertaking(s) |
| 1.5 Compliance
The undertaking(s) previously licensed is(are) operating in compliance with the provisions of its(their) licence(s), the Broadcasting Act, all applicable regulations, policies and mandatory orders of the CRTC. |
| Yes ( ) No ( ) |
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If NO, provide the full details of any non-compliance during the licence term, including the reasons, any remedial action and, where applicable, the period of time expected before the undertaking(s) is(are) operating in compliance. Date: At: Signature of Licensee or its appointed agent: |
1.6 Procedural requestThe Canadian Radio-television and Telecommunications Commission Rules of Practice and Procedure allow an interested person to request that the Commission exercise a power under the Rules of Procedure or change the Rules of Procedure for a specific proceeding (sections 5 and 7). This is generally called a procedural request. You may consult the Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and the Guidelines on the CRTC Rules of Practice and Procedure, Broadcasting and Telecom Information Bulletin CRTC 2010-959, 23 December 2010, for more information. |
2.Ownership
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Definitions:(1) VOTING SHARES: The shares to which are attached one or more votes, and includes securities that are convertible into such shares at all times at the option of the holder. |
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| If all of the ownership information requested in questions 2.1 to 2.3 has already been submitted to the Commission within the last 12 months and is still current, complete the following: |
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The application number or the date where this information was last supplied: . |
| • | I hereby attest that the information last supplied is accurate and that no changes have been made since then. |
| YES ( ) |
NO ( ) |
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Go to section 3. |
| 2.1 |
For the applicant/licensee, complete the following tables providing: |
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| a) |
A list of the directors and officers, including the Chief Executive Officer. |
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| Name of the corporation for which the following table pertains: | ||||
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DIRECTORS AND OFFICERS |
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Name |
Complete Home Address |
Citizenship |
Directors; |
Officers; |
b) A list of shareholders holding 10% or more of the voting shares(1), of the voting rights (when different from the voting shares), and of the Common(2) (participating) shares, by class of shares. |
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Name of the corporation for which the following table pertains: |
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CAPITAL STRUCTURE AND SHAREHOLDERS |
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Shares/ |
Participating |
Votes |
Authorized |
Issued |
Name of Shareholders |
No. |
% of |
Canadian |
c) A breakdown between Canadian and non-Canadian of the remaining shares not accounted for in b), by class of shares. |
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Name of the corporation for which the following table pertains: |
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Class of |
Shareholders |
Total Number of |
% of |
Canadian |
2.2 |
Complete the following tables for each corporation holding, directly and/or indirectly, 20% or more of the voting interest (shares and/or votes) of the applicant/licensee: |
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| a) |
A list of the directors and officers of the corporation, including the Chief Executive Officer. |
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| Name of the corporation for which the following table pertains: | ||||
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DIRECTORS AND OFFICERS |
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Name |
Complete Home Address |
Citizenship |
Directors; |
Officers; |
b) A list of shareholders holding 10% or more of the voting shares(1), of the voting rights (when different from the voting shares), and of the Common(2) (participating) shares, by class of shares. |
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Name of the corporation for which the following table pertains: |
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CAPITAL STRUCTURE AND SHAREHOLDERS |
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Shares/ |
Participating |
Votes |
Authorized |
Issued |
Name of Shareholders |
No. |
% of |
Canadian |
c) A breakdown between Canadian and non-Canadian of the remaining shares not accounted for in b), by class of shares. |
| Name of the corporation for which the following table pertains: | ||||
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Class of |
Shareholders |
Total Number of |
% of |
Canadian |
2.3 |
Complete the same tables as in 2.2 for each corporation holding, directly and/or indirectly, 20% or more of the voting interest (shares and/or votes) of the corporations in 2.2 b), and for any corporation forming part of their ownership chain. |
Supporting document to be appended:
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| Appendix 2A |
A copy of all changes or amendments to the constituting documents (for example, Letters Patent, By-Laws, etc.) of the applicant/licensee and of the corporations listed in 2.2 and 2.3, that are not already filed with the Commission. |
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3. Industry consolidation and cross-media ownership
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Section 3 - To be completed only if applying for a regional cable licence |
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| If the information requested in this section is already on file with the Commission and is still current, complete the following: |
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The application number or the date where this information was last supplied: |
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Go to section 4. |
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| 3.1 |
Provide a list of all entities involved in any of the areas listed below, for which any investment (equity and/or debt securities) is held by the applicant/licensee, a corporation which directly or indirectly controls the applicant/licensee and any shareholder holding 20% or more of the voting shares and/or rights of the applicant/licensee. |
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| a) |
Other CRTC licence holder and exempted undertakings |
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| b) |
Daily newspaper |
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| c) |
Non-daily newspaper or other media publisher |
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Production or distribution of programming material |
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Lessor of property, plant or equipment of licensee |
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| f) |
Telecommunications company regulated under the Telecommunications Act |
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| g) |
Company owning securities in any of categories (a) to (f) |
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4. Employment equityInformation relating to employment equity is available in Public Notices CRTC 1992-59 and 1997-34. |
| The Commission requires responses to questions regarding Employment Equity on behalf of the applicant/licensee as a whole, with reference to all of its employees in aggregate, that is, employees at all undertakings for which the licensee holds licences. |
| 4.1
Is the applicant/licensee subject to the 1996 Employment Equity Act (applicable to federally-regulated employers with 100 or more employees)? |
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Yes ( ) No ( ) |
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If YES, go to section 5. |
| 4.2
Outline examples of any measures (including hiring and training, apprenticeship programs, work arrangements, etc.) that you have or will put in place for the
designated groups (women, Aboriginal peoples, persons with disabilities and visible minorities). |
| Questions 4.3 to 4.5 - Applicable if between 25 and 99 employees only: |
| 4.3
How do you or will you communicate details of your employment equity policies to managers and staff? |
| 4.4
Have you assigned, or will you assign, a senior level person to be responsible for tracking progress and monitoring results? |
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Yes ( ) No ( ) |
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If YES, what authority does or will that person have to ensure goals are achieved? |
| 4.5
What financial resources do you have or will you put in place to promote employment equity in the workplace (for example, funds for daycare, access for persons
with disabilities, etc.)? |
5. Service information - Individual cable
licence renewal
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Section 5 - To be completed only if applying for an individual cable licence renewal |
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| 5.1 |
Please indicate the location of the licensed area, as indicated on the current licence, and provide the coordinate of the local head-end, if applicable. |
| 5.2 | Provide the number of basic subscribers. |
| 5.3 |
Distribution of services
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| Provide/confirm a website address where the distribution grid (i.e., the channel lineup) is listed, according to the licensed location. The distribution grid must contain the call sign and location or service name of each programming service, as well as the mode of distribution [basic (B) or discretionary (D)] and channel or frequency on which each signal is distributed (refer to Broadcasting Information Bulletin 2009-384). |
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| 5.4 |
If the undertaking is fully interconnected with another undertaking, specify the primary location of this undertaking: |
| Interconnection with Undertaking | Location |
Access to described video
5.10 Please describe any other mechanisms designed to make your services more accessible for people with disabilities.
Supporting document to be appended: |
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| Appendix 5A | Service area maps (refer to Broadcasting Information Bulletin CRTC 2009-384) |
Provide a service area map that reflects the boundaries of the service area in one of the following formats:
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| A map provided in a standard image or PDF file format must be in a scale that readily permits precise identification of the boundaries of the service area and depicts the location in relation to its surrounding areas. This map must provide a level of detail comparable to that contained in the paper map previously required by the Commission (1:50,000 NTS topographical map). |
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A map provided in a GIS-compatible file format must be created using a map datum of NAD83. The Commission will only accept the following GIS-compatible file extensions:
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| Licensees are encouraged to post their service area maps on their respective websites. |
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6. SERVICE INFORMATION - REGIONAL CABLE LICENCE |
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| 6.1 | Please indicate the location of the licensed areas, as indicated on the current licence of each undertaking that will be part of the proposed regional cable licence and provide the coordinates of the local head-ends, if applicable. |
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Licensed Area |
Head-end |
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YES ( ) Coordinates: |
NO ( ) |
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YES ( ) Coordinates: |
NO ( ) |
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YES ( ) Coordinates: |
NO ( ) |
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| 6.2 | For each undertaking, provide the number of basic subscribers. |
| 6.3 | If applicable, specify new locations you propose to incorporate in this regional licence which are not currently authorized: |
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Primary Location |
Secondary Locations |
Head-end |
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| YES ( ) Coordinates: |
NO ( ) | ||
| YES ( ) Coordinates: |
NO ( ) | ||
| YES ( ) Coordinates: |
NO ( ) | ||
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Interconnection
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| 6.5 | If an undertaking is fully interconnected with another undertaking, specify the primary location of this undertaking: |
| Interconnection with Undertaking | Location |
6.11 Please describe any other mechanisms designed to make your services more accessible for people with disabilities.
Supporting document to be appended:
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| Appendix 6A | Service area maps (refer to Broadcasting Information Bulletin CRTC 2009-384) In the case of existing undertakings: |
Provide a service area map that reflects the boundaries of the service area in one of the following formats:
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| A map provided in a standard image or PDF file format must be in a scale that readily permits precise identification of the boundaries of the service area and depicts the location in relation to its surrounding areas. This map must provide a level of detail comparable to that contained in the paper map previously required by the Commission (1:50,000 NTS topographical map). |
A map provided in a GIS-compatible file format must be created using a map datum of NAD83. The Commission will only accept the following GIS-compatible file extensions:
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| Licensees are encouraged to post their service area maps on their respective websites. In the case of new undertakings: Provide proposed service area maps following the specifications set out above |
Sections 30 to 34 of the Canadian Radio-television and Telecommunications Commission Rules of Practice and Procedure set out a process by which parties to Commission proceedings may file information on the record of a public proceeding in confidence.
A party filing information can “designate” it as confidential at the time it is filed with the Commission (section 31) if it falls into one of the following categories:
At the time that the party files the information it designates as confidential, it must provide an abridged version of the document along with an explanation of how the information falls into a category of information listed in section 31. The party must provide a detailed rationale to explain why the disclosure of the information is not in the public interest (section 32(1)).
The confidential version of the document must be filed separately and must be marked “CONFIDENTIAL” on each page. If the document is filed electronically, each file containing confidential information must include “CONFIDENTIAL” in the file name.
The abridged version of the document and the reasons for the designation of information as confidential will be placed on the public record of the proceeding.
Please consult the Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, 23 December 2010, and the Procedures for filing confidential information and requesting its disclosure in Commission proceedings, Broadcasting and Telecom Information Bulletin CRTC 2010-961, 23 December 2010, for complete process for filing confidential information.
Are you requesting for some information to be designated as confidential?
Yes ( ) No ( )
If yes, you must provide a detailed rationale to explain why the disclosure of the information is not in the public interest :
Book of supporting documents
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APPENDIX NUMBER AND NAME |
APPENDED |
E-FILED |
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SECTION 1: GENERAL INFORMATION |
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1A |
Supplementary Brief | ||
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SECTION 2: OWNERSHIP |
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2A |
Amendments to constituting documents | ||
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SECTION 5: SERVICE INFORMATION - INDIVIDUAL CABLE LICENCE RENEWAL |
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5A |
Service Area Map(s) | ||
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SECTION 6: SERVICE INFORMATION - REGIONAL CABLE LICENCE |
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| 6A | Service Area Maps | ||
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***End of Document*** |