FCC Form 214STA International Section 214 Special Temporary Authority Ap

Approved by OMB
3060-0686

INTERNATIONAL SECTION 214 SPECIAL TEMPORARY AUTHORITY APPLICATION
FCC FORM 214STA
FOR OFFICIAL USE ONLY
[Click here for INSTRUCTIONS.]
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APPLICANT INFORMATION
Note: Use only standard punctuation. Please do not use special characters - such as ';' - in any of the
fields below!
Enter a description of this application to identify it on the main menu:
1. Applicant

DBA
Name:

Phone
Number:
Fax
Number:

Street:

E-Mail:

City:

State:

Country:

Zipcode:

Name:

-

Attention:
2. Contact
Name:

Phone
Number:

Company:

Fax Number:

Street:

E-Mail:

City:

State:

Country:

USA

Attention:
3. Place of Incorporation of Applicant
4. Other Company(ies) and Place(s) of Incorporation

Zipcode:
Relationship:

-

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))

TYPE OF REQUEST
6.

New Request

Extend STA Date

Other

7. Date Authorization Needed:

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.

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

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).
13. Does the applicant seek authority to provide service to any destination described in paragraphs (1)
through (4) of Section 63.18(j)? If yes, list those destinations in Attachment 1 as a response to
question 12.

Yes

No

14. Does the applicant seek authority to provide service to any destinations other than those listed in
response to 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.

Yes

No

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 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

No

18. By checking Yes, the applicant certifies that it has not agreed to accept special concessions
directly or 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.

Yes

No

CERTIFICATION
19. Typed Name of Person Signing

20. Title of Person Signing

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

2:

Attachment

3:

Attachment

FCC NOTICE REQUIRED BY THE PAPERWORK REDUCTION ACT
The public reporting for this collection of information is estimated to average 2 hours per response, i ncluding
the time for reviewing instructions, searching existing data sources, gathering and maintaining the re quired
data, and completing and reviewing the collection of information. If you have any comments on this burd en
estimate, or how we can improve the collection and reduce the burden it causes you, please write to the Fede
ral Communications Commission, AMD-PERM, Paperwork Reduction Project (3060-0686), Washington, DC
20554. We wil l also accept your comments regarding the Paperwork Reduction Act aspects of this collection
via the Internet i f you send them to [email protected]. PLEASE DO NOT SEND YOUR RESPONSE 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 numbe r of 3060-0686.
THE FOREGOING NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995,
PUBLIC LAW 104-13, OCTOBER 1, 19 95, 44 U.S.C. SECTION 3507.
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