Application Form [pdf]

This document pretains to ITC-STA-20120703-00168 for Special Temporal Authority on a International Telecommunications filing.

IBFS_ITCSTA2012070300168_958751

                                                                                                                     Approved by OMB
                                                                                                                            3060−0686


                        INTERNATIONAL SECTION 214 SPECIAL TEMPORARY AUTHORITY APPLICATION
                                                       FCC FORM 214STA
                                               FOR OFFICIAL USE ONLY

             APPLICANT INFORMATION Enter a description of this application to identify it on the main menu:
 authority to provide international global facilities−based and resale authority pending review of Petition to Deny Applicant
1. Applicant

         Name:           Rubard LLC d/b/a Centmobile       Phone Number:                     917−597−8215
         DBA Name:                                         Fax Number:
         Street:         BOX 180671878                     E−Mail:                           compliance@rubard.com


         City:           Sioux Falls                       State:                            SD
         Country:         USA                              Zipcode:                          57186    −
         Attention:      Mr Alexander Dzerneyko




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2. Contact

          Name:            Rubard LLC d/b/a Centmobile          Phone Number:         917−597−8215
          Company:                                              Fax Number:
          Street:          BOX 180671878                        E−Mail:               compliance@rubard.com


          City:            Sioux Falls                          State:                SD
          Country:         USA                                  Zipcode:              57186   −
          Contact Title:                                        Relationship:


    3. Place of Incorporation of ApplicantDelaware
 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))




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     TYPE OF REQUEST
     6.       New Request          Extend STA Date           Other              7. Date Authorization Needed:07/03/2012


8.            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):

9. Description of Special Temporary Authority Requested.
(If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.)
                         authority to provide international global facilities−based and resale
                         authority pending review of Petition to Deny Applicant




10. In Attachment 1, provide justification of need for special temporary authority requested.


11. If this request for Special Temporary Authority is associated with any pending applications filed with the Commission, enter either the file
number [e.g., ITC−214−19930101−23412] or the IB Submission ID of the pending application [e.g., IB200311111] AND go to question 16.)
File Number ITC2142012051800134 or Submission ID
Applicant certifies that its responses to questions 11 through 17 are true:

    12. 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).




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13. Does the applicant seek authority to provide service to any destination described in paragraphs (1) through (4)          Yes            No
of Section 63.18(j)? If yes, list those destinations in Attachment 1 as a response to question 12.



14. Does the applicant seek authority to provide service to any destinations other than those listed in response to          Yes            No
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.



    15. [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.



    16. In Attachment 1, respond to paragraphs (d), (e)(3) and (g) of Section 63.18.



17. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is              Yes            No
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.



18. By checking Yes, the applicant certifies that it has not agreed to accept special concessions directly or                Yes            No
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.




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    CERTIFICATION
19. Typed Name of Person Signing                                           20. Title of Person Signing
Alexander Dzerneyko                                                        Manager
          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).



         21.1:    Attachment 1                       2:    Attachment 2                           3:     Attachment 3




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THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104−13, OCTOBER
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Document Created: 2019-04-16 03:02:33
Document Modified: 2019-04-16 03:02:33

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