ISP-PDR Form REV to OMD March 21 2024

DRAFT – March 2024

FCC [[#]] ISP-PDR

FCC Form for Section 310(b) Petition for Declaratory Ruling Office of International Affairs

Not Yet Approved by OMB No.3060-1163 Estimated time per response: 50-170 Edition date: [XXXX 2024]

[link to instructions]

Petitioner Information

1. Petitioner Information

   • FRN

   • Petitioner/Licensee Legal Entity Type (Select One)

• Individual: (check box)

• Unincorporated Association: (check box)

• Government Entity: (check box)

• Corporation: (check box)

• Limited Liability Company: (check box)

• General Partnership: (check box)

• Limited Partnership: (check box)

• Limited Liability Partnership: (check box)

• Consortium: (check box)

• Other: (check box) and then (Fill-in box)

• Name and title; Doing Business As (DBA), address; phone; fax; email; attention to (imported from CORES during authentication).

2. Contact Information

   • Check here if same as Petitioner. (Check Box)

   • (If different from the Petitioner). Name and title; Doing Business As (DBA), company name; relationship, address; phone; fax; email; (individual fields editable)

3a. Contact for execution of lawful requests.

FRN [text box]

Individual Name: [text box]

Company: [text box]

Telephone number: [text box]

Fax number: [text box]

Email: [text box]

Complete business address [text box]

Alternate contact for execution of lawful requests (optional)

(check box) Select if alternate contact has been designated.

[If check box is selected, then Applicant fills in the following information.]

FRN [text box]

Alternate Individual Name: [text box]

Alternate Company: [text box]

Alternate Telephone number: [text box]

Alternate Fax number: [text box]

Alternate Email: [text box]

Alternate Complete business address: [text box]

3b. Agent for legal service of process

(check box) Select if agent is same as contact for execution of lawful requests.

[If check box is not selected, then Applicant fills in the following information.]

FRN [text box]

Individual Name: [text box]

Company: [text box]

Telephone number: [text box]

Fax number: [text box]

Email: [text box]

Complete business address: [text box]

Alternate contact for execution of lawful requests (optional)

(check box) Select if alternate contact has been designated.

[If check box is selected, then Applicant fills in the following information.]

FRN [text box]

Alternate Individual Name: [text box]

Alternate Company: [text box]

Alternate Telephone number: [text box]

Alternate Fax number: [text box]

Alternate Email: [text box]

Alternate Complete business address: [text box]

Petition Information

4. Brief Description of the Petition: (editable field)

4. Does the Petitioner have a current declaratory ruling to permit foreign investment above the benchmarks in section 310(b) of the Act?

• Yes (check box)

• No (check box)

If yes, enter below the ICFS File No(s). and select whether in compliance.

5a. ICFS File No(s): [a fill-in box]

5b. Is the Petitioner in compliance with the current ruling?

• Yes (check box)

• No (check box) You must make a filing in the file for the current ruling explaining why you are no longer in compliance pursuant to 47 CFR § 1.5004(f)

4. FCC Authorizations and Applications Associated with Petition, if any. Refer to section 1.5001(c)(2)(i) of the Commission’s rules.

6a. Does the Petitioner currently hold or control a: (1) common carrier wireless license or spectrum lease; or (2) common carrier earth or space station license?

• Yes (check box)

• No (check box)

If yes, enter below the ICFS File No(s) and/or ULS File No(s).

ICFS File No(s): [fill-in box]

ULS File No(s): [ill-in box]

6b. Related Common Carrier Filings. Are there other contemporaneous or pending filings that are associated with the Petition, such as applications to acquire a common carrier wireless license and/or spectrum lease; and/or a common carrier earth station license and/or space station license?

• Yes (check box)

• No (check box)

If yes, enter below the ICFS File No(s), ULS File No(s), and/or Docket No(s). if known.

ICFS File No(s): [fill-in box]

ULS File No(s): [fill-in box]

Docket No(s): [fill-in box]

6c. Related Section 214 Applications. Is the Petition being submitted as part of a transaction that includes applications to transfer control of or assign domestic and/or international section 214 authorization(s)?

• Yes (check box)

• No (check box)

If yes, enter below the Docket No., ICFS File No(s)., ULS File No(s)., Docket No(s). and any other relevant FCC license/authorization by Call Sign or File No., if known.

ICFS File No(s): [fill-in box]

ULS File No(s): [ill-in box]

Docket No(s): [a fill-in box]

Other: [fill in box]

6d. Related Non-Common Carrier and Other Filings. Is the Petition being submitted as part of a transaction that includes non-common carrier (private) wireless licenses and/or spectrum leases; non-common carrier (private) earth station licenses and/or space station licenses; and/or other FCC licenses?

• Yes (check box)

• No (check box)

4. Under Which Rule is the Petition Filed?

1. § 1.5000(a)(1). Petitioner requests approval of foreign ownership in the controlling U.S.-organized parent of the common carrier licensee(s), spectrum lessee(s), or Applicant(s) pursuant to section 310(b)(4) of the Communications Act, 47 U.S.C. § 310(b)(4), and section 1.5000(a)(1) of the Commission’s rules. [check box]

[If this option is checked, the questions and tables in “Supplement I/ section 1.5000(a)(1) request” below will appear]

2. § 1.5000(a)(2). Petitioner requests approval of foreign ownership in the common carrier licensee(s), spectrum lessee(s), or Applicant(s) itself, and/or in an intervening U.S.-organized entity that does not control the licensee(s), spectrum lessee(s) or Applicant(s), pursuant to section 310(b)(3) of the Communications Act, 47 U.S.C. § 310(b)(3), and section 1.5000(a)(2) of the Commission’s rules. [check box]

[If this option is checked, the questions and tables in “Supplement II/ section 1.5000(a)(2) request” below will appear]

4. Does this Petitioner qualify for exclusion from referral to the Executive Branch because the only reportable foreign ownership is through wholly owned intermediate holding companies and the ultimate ownership and control is held by U.S. citizens or entities?

   1. Yes (check box) Petitioner must make and attach a specific showing in its application that it qualifies for the exclusion(s), as provided in 47 CFR § 1.40001(a)(2).

   2. No (check box)

4. Petitioner shall submit:

   1. Responses to standard questions, prior to or at the same time the Petitioner files its petition with the Commission, pursuant to part 1, subpart CC, of the Commission’s rules, to the Committee for the Assessment of Foreign Participation in the United States Telecommunications Services Sector (Committee). The required information shall be submitted separately from the application and shall be submitted directly to the Committee.

   2. A complete and unredacted copy of its FCC petition(s), including the file number(s) and docket number(s), to the Committee within three (3) business days of filing it with the Commission.

[checkbox]

4. If applicable, the Petitioner has uploaded a statement showing that its petition qualifies for exclusion from referral to the Executive Branch under section 1.40001(a)(2) of the Commission’s rules.

   1. Yes [Check Box]

   2. N/A [Check Box]

Waivers

11. Does the Petitioner request a waiver(s) of the Commission’s rules?  

    • Yes (check box) 

    • No (check box) 

 

11a.  Identify the rule section(s) for which a waiver is sought below and attach the request with a supporting narrative and documentation. 

[Fill-in box] 

Application Fees

11. Will a fee be paid? 

    • Yes (check box) 

    • No (check box) 

12a.  If yes, select the appropriate fee code for the application. 

[Add drop Down box to select fee code]

 12b. If no, indicate reason for fee exemption. 

1. Governmental Entity (check box) 

2. Noncommercial educational license (check box) 

3. Other (Explain) [text box] 

Attachments/Confidential Treatment of Attachments

11. Is the Applicant requesting confidential treatment of an attachment(s) under section 0.459 of the Commission’s rules? 

    • Yes (check box) 

    • No (check box) 

 

The Applicant must upload a supporting statement for the “confidential treatment request(s)” identifying the applicable rule(s) and providing other supporting materials or information. The Applicant must also upload both the Redacted Public version and the Non-Redacted Confidential version of the attachment(s) in the Attachments section below.

Attachment No.	Description of Attachment	Confidential Treatment Requested
Attachment 1	[Fill in description should be searchable]	[confidential box] [not checked]
Attachment 2 (Public Version of Confidential Treatment Request and Supporting Statement)	Show Uploaded Public Version of Confidential Treatment Request (with supporting statement, identifying the applicable rules and other supporting materials and information) [This should be uploaded in response to the Q on Conf Treatment above and show the uploaded doc here]	Show rows below 2(a) and 2(b) If 2(a) and 2(b) are uploaded in response to the Q on Confidential Treatment, show those below as already uploaded.
Attachment 2(a) (Public Redacted Version)	Upload Public Redacted Filing [Upload Button]	[Show this as Public] (if already uploaded, show it as uploaded, no need to upload again.
Attachment 2(b) (Confidential Non-Redacted Version)	Upload Confidential Non-Redacted Filing [Do not make this public] [Upload Button]	[Show this as Confidential] If already uploaded show it as uploaded and confidential, no need to upload again.

Certification Statements and Acknowledgements

11. In submitting this form,

    • The Petitioner certifies that it has submitted all necessary statements and exhibits.

• The Petitioner certifies that it has calculated and disclosed the ownership interests in this petition for declaratory ruling based on the standards set forth in section 1.5000-1.5004 of the Commission’s rules.

• The Petitioner acknowledges that the Commission, in its discretion, may refer applications, petitions, and other filing to the Executive Branch for review for national security, law enforcement, foreign policy, and/or trade policy concerns.

• The Petitioner 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 Petitioner certifies under penalty of perjury under the laws of the United States of America that Petitioner’s statements made in this Petition and in the attachments or documents incorporated by reference are material, are part of this Petition, and are true, complete, correct, and made in good faith.

[check box]

National Security/Law Enforcement Certification Statements

11. In submitting this form, the Petitioner certifies that it will:

• Comply with all applicable Communications Assistance for Law Enforcement Act (CALEA) requirements and related rules and regulations, including any and all FCC orders and opinions governing the application of CALEA, pursuant to the Communications Assistance for Law Enforcement Act and the Commission’s rules and regulations in Title 47, part 1, subpart Z;

• Make communications to, from, or within the United States, as well as records thereof, available in a form and location that permits them to be subject to a valid and lawful request or legal process in accordance with U.S. law, including but not limited to:

• The Wiretap Act, 18 U.S.C. § 2510 et seq.;

• The Stored Communications Act, 18 U.S.C. § 2701 et seq.;

• The Pen Register and Trap and Trace Statute, 18 U.S.C. § 3121 et seq.; and

• Other court orders, subpoenas or other legal process;

• Designate a point of contact who is located in the United States and is a U.S. citizen or lawful U.S. permanent resident, for the execution of lawful requests and as an agent for legal service of process;

• Ensure the continuing accuracy and completeness of all information submitted, whether at the time of submission of the application or subsequently in response to either the Commission or the Committee’s request, as required under section 1.65(a) of the Commission’s rules, and to inform the Commission and the Committee of any substantial and significant changes while an application is pending;

• Ensure that after the application is no longer pending for purposes of section 1.65 of the Commission’s rules, it will notify the Commission and the Committee of any changes in the authorization holder or licensee information and/or contact information promptly, and in any event within thirty (30) days; and

• Fulfill the conditions and obligations set forth in the certifications set out in section 63.18(q)of the Commission’s rules or in the grant of an application or authorization and/or that if the information provided to the United States Government is materially false, fictitious, or fraudulent, it may be subject to all remedies available to the United States Government, including but not limited to revocation and/or termination of the Commission’s authorization or license, and criminal and civil penalties, including penalties under 18 U.S.C. § 1001.

[check box]

11. Party Authorized to Sign

First Name:	MI:	Last Name:		Suffix:
Title:
Signature:			Date:
FAILURE TO SIGN THIS PETITION MAY RESULT IN DISMISSAL OF THE PETITION 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)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).

[reveal only if the Applicant checks § 1.5000(a)(1) above]

Supplement I/Section 1.5000 (a)(1) request: Petitioner requests approval of foreign ownership in the controlling U.S.-organized parent of the common carrier licensee(s), spectrum lessee(s), or Applicant(s) pursuant to section 310(b)(4) of the Communications Act, 47 U.S.C. § 310(b)(4), and section 1.5000(a)(1) of the Commission’s rules.

1. Do any individuals or entities hold, or would they hold, directly 10% percent or more of the equity interests and/or voting interests, or a controlling interest, in the controlling U.S. parent of the petitioning Applicant(s), licensee(s), or spectrum lessee(s), as specified in section 1.5001(e)(4)(i) through (iv) of the Commission’s rules?

• Yes (check box) [If the Petitioner selects yes, bring up chart below]

• No (check box) [go to next question]

Chart: For each such disclosable individual or entity, enter the name; country of organization or citizenship (in the case of an individual); dual or more citizenships (if applicable); and respective direct equity and voting interests below (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Organization/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Minimum Maximum		(4) Voting Percentage Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100.]

[Petitioner should be able to add and delete rows as necessary]

2. Do any individuals or entities hold, or would they hold, indirectly 10% or more of the equity interests and/or voting interests, or a controlling interest, in the controlling U.S. parent of the petitioning Applicant(s), licensee(s), or spectrum lessee(s), as specified in section 1.5001(f)(1) of the Commission’s rules? Equity interests and voting interests held indirectly shall be calculated in accordance with the principles set forth in section 1.5002 of the Commission’s rules.

• Yes (check box) [If the Applicant selects yes, bring up chart below]

• No (check box) (go to next question)

For each such disclosable individual or entity, enter the name; country of organization or citizenship (in the case of an individual); dual or more citizenships (if applicable); and respective indirect equity and voting interests (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Minimum Maximum		(4) Voting Percentage Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]

[Petitioner should be able to add and delete rows as necessary]

3. Does the Petition request specific approval for particular foreign individuals and/or entities as specified in section 1.5001(i) of the Commission’s rules?

• Yes (check box) [If the Applicant selects yes, bring up chart below]

• No (check box) (go to next question)

Enter below the name of each foreign individual and/or entity for which the Petition requests specific approval, if any; the citizenship or, in the case of a foreign entity, the country of formation; dual or more citizenships (if applicable); and the respective percentages of equity and/or voting interests (to the nearest one percent) that each such foreign individual or entity holds, or would hold, directly and/or indirectly, in the controlling U.S. parent of the petitioning Applicant(s), licensee(s), or spectrum lessee(s). Refer to section 1.5001(i) of the Commission’s rules (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Requested Minimum Maximum		(4) Voting Percentage Requested Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]

[Petitioner should be able to add and delete rows as necessary]

4. Enter below an estimate of the percentage of aggregate direct and/or indirect foreign equity interests and the aggregate direct and/or indirect foreign voting interests held or to be held in the controlling U.S. parent of the petitioning Applicant(s), licensee(s), or spectrum lessee(s) (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Direct/Indirect Equity Percentage Requested Minimum Maximum			(2) Direct/Indirect Voting Percentage Requested Minimum Maximum
[Drop-down menu where they can select either “Direct”, “Indirect”, or “N/A”.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Drop-down menu where they can select either “Direct”, “Indirect”, or “N/A”.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]

[Petitioner should be able to add and delete rows as necessary]

5. Is the Petitioner requesting any advance approvals under section 1.5001(k) of the Commission’s rules?

• Yes (check box) [If yes, bring up table below]

• No (check box)

For each individual or entity for which Petitioner requests section 1.5001(k) advance approval, enter below the name; country of organization or citizenship (in the case of an individual); dual or more citizenships (if applicable); and respective equity and voting interests requested (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Requested Minimum Maximum		(4) Voting Percentage Requested Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 to 100 (include 0 and 100)]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 to 100 (include 0 and 100)]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 and 100 (include 0 and 100)]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 to 100 (include 0 and 100)]

[Petitioner should be able to add and delete rows as necessary]

[reveal only if the Applicant checks § 1.5000(a)(2) above]

Supplement II/ Section 1.5000 (a)(2) request: Petitioner requests approval of foreign ownership in the common carrier licensee(s), spectrum lessee(s), or Applicant(s) itself, and/or in an intervening U.S.-organized entity that does not control the licensee(s), spectrum lessee(s) or Applicant(s), pursuant to section 310(b)(3) of the Communications Act, 47 U.S.C. § 310(b)(3), and section 1.5000(a)(2) of the Commission’s rules

1. Do any individuals or entities hold, or would they hold, directly 10% percent or more of the equity interests and/or voting interests, or a controlling interest, in the petitioning Applicant(s), licensee(s), or spectrum lessee(s), as specified in section 1.5001(e)(4)(i) through (iv) of the Commission’s rules?

• Yes (check box) [If the Applicant selects yes, bring up chart below]

• No (check box)

For each such disclosable individual or entity, enter the name; country of organization or citizenship (in the case of an individual); dual or more citizenships (if applicable); and respective direct voting and equity interests below (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Minimum Maximum		(4) Voting Percentage Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 and to 100 (include 0 and 100.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100). ]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100). ]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (include 0 and 100).]

[Petitioner should be able to add and delete rows as necessary]

2. Do any individuals or entities hold, or would they hold, indirectly 10% more of the equity interests and/or voting interests, or a controlling interest, in the petitioning Applicant(s), licensee(s), or spectrum lessee(s), as specified in section 1.5001(f)(1) of the Commission’s rules? Equity interests and voting interests held indirectly shall be calculated in accordance with the principles set forth in section 1.5002 of the Commission’s rules.

• Yes (check box) [If the Applicant selects yes, bring up chart below]

• No (check box) (go to next question)

For each such disclosable individual or entity, enter the name; country of organization or citizenship (in the case of an individual); dual or more citizenships (if applicable); and respective indirect equity and voting interests (where the Equity or Voting percentages do not consist of a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Minimum Maximum		(4) Actual Voting Percentage Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100). ]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to100 (including 0 and 100).]

[Petitioner should be able to add and delete rows as necessary]

3. Does the petition request specific approval for particular foreign individuals and/or entities as specified in section 1.5001(i) of the Commission’s rules?

• Yes (check box) [If the Applicant selects yes, bring up chart below]

• No (check box) (go to next question)

Enter below the name of each foreign individual and/or entity for which the petition requests specific approval, if any; the citizenship or, in the case of a foreign entity, the country of formation; dual or more citizenships (if applicable); and the respective percentages of equity and/or voting interests (to the nearest one percent) that each such foreign individual or entity holds, or would hold, directly and/or indirectly, in the petitioning Applicant(s), licensee(s), or spectrum lessee(s). Refer to section 1.5001(i) of the Commission’s rules (where the Equity or Voting percentages consist of a single number, rather than a range, enter that number for the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Requested Minimum Maximum		(4) Voting Percentage Requested Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to100 (including 0 and 100). ]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to100 (including 0 and 100).]

[Petitioner should be able to add and delete rows as necessary]

4. Enter below an estimate of the percentage of aggregate direct and/or indirect foreign equity interests and the aggregate direct and/or indirect foreign voting interests held or to be held in the petitioning Applicant(s), licensee(s), or spectrum lessee(s) (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Direct/Indirect Equity Percentage Requested Minimum Maximum			(2) Direct/Indirect Voting Percentage Requested Minimum Maximum
[Drop-down menu where they can select either “Direct”, “Indirect”, or “N/A”.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100). ]	Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100). ]	[Drop-down menu where they can select either “Direct”, “Indirect”, or “N/A”.]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100).]	[Fill in Field. Percentage should be a whole number. Validation Check: Must be an integer from 0 to 100 (including 0 and 100). ]

[Petitioner should be able to add and delete rows as necessary]

5. Is the Petitioner requesting any advance approvals?

• Yes (check box) [If yes, bring up table below]

• No (check box)

For each individual or entity for which Petitioner requests section 1.5001(k) advance approval, enter below the name; country of organization or citizenship (in the case of an individual); dual or more citizenships (if applicable); and respective equity and voting interests requested (where the Equity or Voting percentages consist of a single number rather than a range, enter that number for both the “Minimum” and “Maximum”):

(1) Entity/ Individual	(2) Country of Incorporation/ Citizenship	(2)(a) Dual or more citizenships (if applicable)	(3) Equity Percentage Requested Minimum Maximum		(4) Voting Percentage Requested Minimum Maximum
[Fill-in Field]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Drop-down menu of all countries with the option to select “Other” which will open a fill-in field.]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 to 100 (include 0 and 100)]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 ato100 (include 0 and 100)]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 to 100 (include 0 and 100)]	[Fill in Field. Percentage rounded to two decimal places. Validation Check: Must be a number with up to 2 decimal places from 0 to 100 (include 0 and 100)]

[Petitioner should be able to add and delete rows as necessary]

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