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IBFS Form - IBFS Portal
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FCC 427
Application for International High Frequency
Program Test Authority
FOR OFFICIAL USE ONLY
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Approved by OMB: 3060-1035
Estimated time per response: 2 hours
Edition Date: April 2023
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DRAFT-IHF-LIC-20230421-00022
1. Applicant Information
FRN
Name
Attention
Doing Business As (DBA)
Title
Street Address
Phone
Street Address 2
Fax
City
Email
State
Zip Code/Postal Code
Country
Contact same as Applicant
2. Contact Information
FRN
Name
Doing Business As (DBA)
Street Address
Street Address 2
Attention
Title
Phone
Fax
City
Email
State
Relationship
-- None --
Zip Code/Postal Code
Country
Application Information
3. Brief Application Description
https://fccuat.servicenowservices.com/ibfs?id=app&subsystem=IHF&type=PTA
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4/28/23, 10:04 AM
IBFS Form - IBFS Portal
Begin Date
End Date
YYYY-MM-DD
YYYY-MM-DD
Waivers
Does the Applicant request a waiver(s) of the Commission's rules?
Yes
No
Confidential Treatment of Attachments
Is the Applicant requesting confidential treatment of an attachment(s) under section 0.459 of the Commission's rules?
Yes
No
Attachment No.
File Name
Description of Attachment
Confidential
Action
No Attached Files
Attach File
Certification Statements and Acknowledgements
In submitting this form
• The Applicant certifies that neither it nor any other party to the application is subject to a denial of Federal benefits, including FCC benefits, pursuant to section 5301 of the Anti-Drug Abuse Act of 1988, 21 U.S.C. §
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. This certification does not apply to
applications filed in services exempted under § 1.2002(c) of the rules, or to Federal, State or local governmental entities or subdivisions thereof. See 47 CFR § 1.2002(c).
• The Applicant confirms its understanding that it hereby 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. (See Section 304 of the Communications Act of 1934, as amended.)
• The Applicant confirms its understanding that it represents that this application is not filed for the purpose of impeding, obstructing, or delaying determination on any other application with which it may be in
conflict.
• The Applicant acknowledges that all the statements made in this application and attached exhibits are considered material representations, and that all the exhibits are a material part hereof and are incorporated
herein as is set out in full the application.
• The Applicant certifies that all of its statements made in this Application and in the attachments or documents incorporated by reference are material, are part of this Application, and are true, complete, correct, and
made in good faith.
First Name
MI
Last Name
Suffix
Title
Signature
Date
2023-04-28
FAILURE TO SIGN THIS FORM MAY RESULT IN DISMISSAL
OF THE APPLICATION AND FORFEITURE OF ANY FEES PAID
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 LICENSE OR CONSTRUCTION PERMIT
(U.S. Code, Title 47, Section 312(a)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503)
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Review to Submit
Required information
FRN
Name
Street Address
City
State
Zip Code/Postal Code
Country
Attention
Title
Phone
Is the Applicant requesting confidential treatment of an attachment(s) under section 0.459 of the Commission's rules?
Email
Relationship
In submitting this form
Does the Applicant request a waiver(s) of the Commission's rules?
First Name
Last Name
Title
Signature
https://fccuat.servicenowservices.com/ibfs?id=app&subsystem=IHF&type=PTA
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| File Type | application/pdf |
| File Modified | 2023-04-28 |
| File Created | 2023-04-28 |