Application Form SES-STA-20191211-01688

Application Form

This document pretains to SES-STA-20191211-01688 for Special Temporal Authority on a Satellite Earth Station filing.

Approved by OMB
3060-0678

APPLICATION FOR EARTH STATION SPECIAL TEMPORARY AUTHORITY

APPLICANT INFORMATION

Enter a description of this application to identify it on the main menu:

STA- Call Sign # E190489

1. Applicant

Name:	SES Americom, Inc.	Phone Number:	202-478-7143
DBA Name:		Fax Number:	202-478-7111
Street:	1129 20th Street NW	E-Mail:	petra.vorwig@ses.com
	Suite 1000
City:	Washington	State:	DC
Country:	USA	Zipcode:	20036 -
Attention:	Ms Petra A Vorwig

2. Contact

Name:	George Varkey	Phone Number:	6099874327
Company:	SES	Fax Number:
Street:	4 Research Way	E-Mail:	george.varkey@ses.com

City:	Princeton	State:	NJ
Country:	USA	Zipcode:	08540 -
Attention:		Relationship:	Engineer

(If your application is related to an application filed with the Commission, enter either the file number or the IB Submission ID of the related application. Please enter only one.)
3. Reference File Number SESLIC2019061100756 or Submission ID

4a. 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):

4b. Fee Classification CGX - Fixed Satellite Transmit/Receive Earth Station

5. Type Request

Use Prior to Grant

Change Station Location

Other

6. Requested Use Prior Date
01/15/2020

7. CityKooluloa

8. Latitude
(dd mm ss.s h) 21 40 16.4 N

9. State HI

10. Longitude
(dd mm ss.s h) 158 1 52.8 W

11. Please supply any need attachments.

Attachment 1: STA Narrative

Attachment 2:

Attachment 3:

12. Description. SES Americom, Inc request Special Temporary Authorization (STA) for 60 days starting from 15th Jan, 2020 for the earth stations under call sign # E190484 in order to conduct the performance tests of the earth stations and offer services subsequently while the application for the grant of license is in pending.

13. By checking Yes, the undersigned certifies that neither applicant nor any other party to the application is 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.

Yes

14. Name of Person Signing
Petra A. Vorwig

15. Title of Person Signing
Senior Legal & Regulatory Counsel

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).

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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.