Application Form [pdf]

This document pretains to SAT-PPL-20050427-00092 for Permitted List on a Satellite Space Stations filing.

IBFS_SATPPL2005042700092_428997

Approved by OMB 3060−0678 Date & Time Filed: Apr 27 2005 5:40:36:530PM File Number: SAT−PPL−20050427−00092 Callsign/Satellite ID: S2672 APPLICATION FOR SATELLITE SPACE STATION AUTHORIZATIONS FCC Use Only FCC 312 MAIN FORM FOR OFFICIAL USE ONLY APPLICANT INFORMATION Enter a description of this application to identify it on the main menu: Intelsat North America LLC Change of Ownership of Permitted List Satellite 1−8. Legal Name of Applicant Name: Intelsat North America LLC Phone Number: 202−944−7848 DBA Name: Fax Number: 202−944−7860 Street: c/o Intelsat Global Svc. Corp. E−Mail: susan.crandall@intelsat.com 3400 International Drive, N.W. City: Washington State: DC Country: USA Zipcode: 20008 −3006 Attention: Susan H Crandall 1

9−16. Name of Contact Representative Name: Susan H. Crandall Phone Number: 202−944−7848 Company: Intelsat Global Svc. Corp. Fax Number: 202−944−7860 Street: 3400 International Drive, N.W. E−Mail: susan.crandall@intelsat.com City: Washington State: DC Country: USA Zipcode: 20008 −3006 Attention: Susan H Crandall Relationship: Same CLASSIFICATION OF FILING 17. Choose the buttonnext to the b. classification that applies to thisfiling for b1. Application for License of New Station both questions a. and b. Choose only one (N/A) b2. Application for Registration of New Domestic Receive−Only Station for 17a and only one for 17b. (N/A) b3. Amendment to a Pending Application (N/A) b4. Modification of License or Registration a. (N/A) b5. Assignment of License or Registration (N/A) a1. Earth Station (N/A) b6. Transfer of Control of License or Registration a2. Space Station (N/A) b7. Notification of Minor Modification (N/A) b8. Application for License of New Receive−Only Station Using Non−U.S. Licensed Satellite b9. Letter of Intent to Use Non−U.S. Licensed Satellite to Provide Service in the United States b10. Replacement Satellite Application − no new frequency bands b11. Replacement Satellite Application − new frequency bands (Not eligible for streamlined processing) b12. Petition for Declaratory Ruling to be Added to the Permitted List (N/A) b13. Other (Please specify) 2

17c. 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): Permitted List filing−−No fee required 17c. Fee Classification BNY − Space Station (Geostationary) 18. If this filing is in reference to an existing station, enter: (a) Call sign of station: Not Applicable 19. If this filing is an amendment to a pending application enter: (a) Date pending application was filed: (b) File number of pending application: Not Applicable Not Applicable 3

TYPE OF SERVICE 20. NATURE OF SERVICE: This filing is for an authorization to provide or use the following type(s) of service(s): Select all that apply: a. Fixed Satellite b. Mobile Satellite c. Radiodetermination Satellite d. Earth Exploration Satellite e. Direct to Home Fixed Satellite f. Digital Audio Radio Service g. Other (please specify) 21. STATUS: Choose thebutton next to the applicable status. Choose 22. If earth station applicant, check all that apply. only one. Not Applicable Common Carrier Non−Common Carrier 23. If applicant is providng INTERNATIONAL COMMON CARRIER service, see instructions regarding Sec. 214 filings. Choose one.Are these facilities: Connected to a Public Switched Network Not connected to a Public Switched Network N/A 24. FREQUENCY BAND(S):Place an "X" in the box(es) next to all applicable frequency band(s). a. C−Band (4/6 GHz) b. Ku−Band (12/14 GHz) c.Other (Please specify upper and lower frequencies in MHz.) Frequency Lower: Frequency Upper: (Please specify additional frequencies in an attachment) 4

TYPE OF STATION 25. CLASS OF STATION: Choose thebutton next to the class of station that applies. Choose only one. (N/A) a. Fixed Earth Station (N/A) b. Temporary−Fixed Earth Station (N/A) c. 12/14 GHz VSAT Network (N/A) d. Mobile Earth Station e. Geostationary Space Station. f. Non−Geostationary Space Station g. Other (please specify) 26. TYPE OF EARTH STATION FACILITY: Not Applicable PURPOSE OF MODIFICATION 27. The purpose of this proposed modification is to: (Place an "X" in the box(es) next to all that Not Applicable apply.) ENVIRONMENTAL POLICY 28. Would a Commission grant of any proposal in this application or amendment have a significant environmental Yes No impact as defined by 47 CFR 1.1307? If YES, submit the statement as required by Sections 1.1308 and 1.1311 of the Commission’s rules, 47 C.F.R. §§ 1.1308 and 1.1311, as an exhibit to this application. A Radiation Hazard Study must accompany all applications for new transmitting facilities, major modifications, or major amendments. ALIEN OWNERSHIP Earth station applicants not proposing to provide broadcast, common carrier, aeronautical en route or aeronautical fixed radio station services are not required to respond to Items 30−34. 5

29. Is the applicant a foreign government or the representative of any foreign government? Yes No N/A 30. Is the applicant an alien or the representative of an alien? Yes No N/A 31. Is the applicant a corporation organized under the laws of any foreign government? Yes No N/A 32. Is the applicant a corporation of which more than one−fifth of the capital stock is owned of record or voted by Yes No N/A aliens or their representatives or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country? 33. Is the applicant a corporation directly or indirectly controlled by any other corporation of which more than Yes No N/A one−fourth of the capital stock is owned of record or voted by aliens, their representatives, or by a foreign government or representative thereof or by any corporation organized under the laws of a foreign country? 34. If any answer to questions 29, 30, 31, 32 and/or 33 is Yes, attach as an exhibit an identification of the aliens or Attachment 2 foreign entities, their nationality, their relationship to the applicant, and the percentage of stock they own or vote. BASIC QUALIFICATIONS 6

35. Does the Applicant request any waivers or exemptions from any of the Commission’s Rules? Yes No If Yes, attach as an exhibit, copies of the requests for waivers or exceptions with supporting documents. 36. Has the applicant or any party to this application or amendment had any FCC station authorization or license Yes No revoked or had any application for an initial, modification or renewal of FCC station authorization, license, or construction permit denied by the Commission? If Yes, attach as an exhibit, an explination of circumstances. 37. Has the applicant, or any party to this application or amendment, or any party directly or indirectly controlling Yes No the applicant ever been convicted of a felony by any state or federal court? If Yes, attach as an exhibit, an explination of circumstances. 38. Has any court finally adjudged the applicant, or any person directly or indirectly controlling the applicant, Yes No guilty of unlawfully monopolizing or attemptiing unlawfully to monopolize radio communication, directly or indirectly, through control of manufacture or sale of radio apparatus, exclusive traffic arrangement or any other means or unfair methods of competition? If Yes, attach as an exhibit, an explanation of circumstances 39. Is the applicant, or any person directly or indirectly controlling the applicant, currently a party in any pending Yes No matter referred to in the preceding two items? If yes, attach as an exhinit, an explanation of the circumstances. 7

40. If the applicant is a corporation and is applying for a space station license, attach as an exhibit the names, address, and citizenship of those stockholders owning a record and/or voting 10 percent or more of the Filer’s voting stock and the percentages so held. In the case of fiduciary control, indicate the beneficiary(ies) or class of Attachment 3 beneficiaries. Also list the names and addresses of the officers and directors of the Filer. 41. 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. 42a. Does the applicant intend to use a non−U.S. licensed satellite to provide service in the United States? If Yes, Yes No answer 42b and attach an exhibit providing the information specified in 47 C.F.R. 25.137, as appropriate. If No, proceed to question 43. 42b. What administration has licensed or is in the process of licensing the space station? If no license will be issued, what administration has coordinated or is in the process of coordinating the space station? Papua New Guinea 8

43. Description. (Summarize the nature of the application and the services to be provided). (If the complete description does not appear in this box, please go to the end of the form to view it in its entirety.) Notification of Change of Ownership of Permitted List Satellite IA−13 to Intelsat Holdings, Ltd. (formerly Zeus Holdings Limited) Attachment 4 CERTIFICATION The Applicant waives any claim to the use of any particular frequency or of the electromagnetic spectrum as against the regulatory power of the United States because of the previous use of the same, whether by license or otherwise, and requests an authorization in accordance with this application. The applicant certifies that grant of this application would not cause the applicant to be in violation of the spectrum aggregation limit in 47 CFR Part 20. All statements made in exhibits are a material part hereof and are incorporated herein as if set out in full in this application. The undersigned, individually and for the applicant, hereby certifies that all statements made in this application and in all attached exhibits are true, complete and correct to the best of his or her knowledge and belief, and are made in good faith. 44. Applicant is a (an): (Choose the button next to applicable response.) Individual Unincorporated Association Partnership Corporation Governmental Entity Other (please specify) Limited liability company 45. Name of Person Signing 46. Title of Person Signing Susan H. Crandall Assistant General Counsel 9

47. Please supply any need attachments. 1: Attachment 1 2: 3: 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). FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT The public reporting for this collection of information is estimated to average 2 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 (3060−0678), 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 jboley@fcc.gov. PLEASE DO NOT SEND COMPLETED FORMS 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 3060−0678. 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. 10


Document Created: 2019-04-12 08:28:06
Document Modified: 2019-04-12 08:28:06
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