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---iTVRO REGISTRATION CERTIFIcATE i --- rvno srATrolv LrcENsE i cArv srAnoN LrcENsE fNSTRUCTIONS All blanks must be filled up properly. -. -. i i i EMAIL ADD. Commercial i Non-Commercial 5 BUSINESS APPLICANT i j Broadcasting icArv iiothers 6 EXACT LOCATION OF TVRO SYSTEM street MUnrc parlty tsarangay Latitude Longitude 7 SERVICE AREAS Use separate sheet s for the list of service areas 8 INTENDED USE OF TVRO SYSTEM I i -j PARTICUIARS OF EQUIPMENT s lf Applicable L.N.B. RECEIVERS 10 OTHER EQUIPMENT 11 ANTENNA SYSTEM Use Separate Sheets if installed Satellite Dish is more than one 12 SIGNALS TO BE RECEIVED Use Separate Sheets if needed RECEIVED FREQUENCY SATELLITE Authorized Representative Signature over Printed Nameof Applicant REMARKS Date --------t iORXI i i tl iI AMOUNT CASHIER iI No. t-------------- --- - -l iRevision NOTFOR SAIE AND CAN BE REPRODUCED TH S FORM S DOCUMENTARY REQUIREM ENTS FOR SUB SS OA NEW 1 Duly accomplished Application form for TVRO Station License 2 Engineering Plans and Diagrams signed and sealed by a duly licensed PECE 1 A map of appropriate scale 1 150 000 is prefened showing the location of the TVRO station place at the center of the map Flan 2 Properly labeled block diagram of the proposed TVRO system ptan Plan Antenna system with technical specifications Copy of issued Provisional Authority/Certificate of Authority Swom Statement of Employment of the Supervising PECE attached valid authenticated copy PECE license Technician Certifi cate Written athorization from the pay program originator/s or network sending the pay program via satellite must be attached togetherwith this application RENEWAL 2 Copy of valid Business/Mayofs Permit 4 attached valid authenticateO copy PECE license 6 Original TVRO/CATV Station License 7 Copy of payment of latest Supervision and Regulatory Fee 8 Proof of Employees Remittance to SSS NTC REGIONAL OFFICE NO. Pint all entries in block or CAPITAI IETTERS r--. TYPE iL-. -J i Newi Ren NUMBER OF YEARS l----t L---J 1----l i--ibne i-lro i--irnr APPLICANT 2 BUSINESS ADDRESS 3 GONTACT NO s 4 CLASSIFICATION OF TVRO CATV APPLICANT t---i. -. -. i i i EMAIL ADD. Commercial i Non-Commercial 5 BUSINESS APPLICANT i j Broadcasting icArv iiothers 6 EXACT LOCATION OF TVRO SYSTEM street MUnrc parlty tsarangay Latitude Longitude 7 SERVICE AREAS Use separate sheet s for the list of service areas 8 INTENDED USE OF TVRO SYSTEM I i -j PARTICUIARS OF EQUIPMENT s lf Applicable L.N.B. NTC Form fito. Republic of the Philippines NATIONAL TELECOMMUNICATIONS COMMISSION Agham Road East-Triangle Diliman Quezon City APPLICATION FOR APPL.AT Reference No i. Put n/a for items not applicable to you. Upon completion of the form submit this together with rcquired/supporting documents. Pint all entries in block or CAPITAI IETTERS r--. TYPE iL-. -J i Newi Ren NUMBER OF YEARS l----t L---J 1----l i--ibne i-lro i--irnr APPLICANT 2 BUSINESS ADDRESS 3 GONTACT NO s 4 CLASSIFICATION OF TVRO CATV APPLICANT t---i. Put n/a for items not applicable to you. Upon completion of the form submit this together with rcquired/supporting documents.

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