DRAFT – March 2024
ITC-ASG/TC Form
FCC [[#]] ITC-ASG/TC |
FCC Application for Assignment or Transfer of Control of an International Section 214 Authorization
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Not Yet Approved by OMB No. 3060-0686 Estimated time per response: 9-130 Edition Date: [XXXX 2024] |
[link to instructions]
International Section 214 Authorization Holder Information
Authorization Holder Information.
FRN [text box]
Legal Entity Type (Select One)
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)
Other: (check box and a fill-in box)
Name and title; Doing Business As (DBA), address; phone; fax; email; attention to (imported from CORES during authentication)
Contact Information.
Check here if same as Applicant: (check box)
(If different from the Applicant): Name and title; Doing Business As (DBA), company name; relationship, address; phone; fax; email (individual fields are editable)
Assignor/Transferor Information
Assignor/Transferor Information:
FRN [text box]
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)
Other: (a check box and a fill-in box)
Name and title; Doing Business As (DBA), address; phone; fax; email; attention to (imported from CORES during authentication)
Assignor/Transferor Contact Information:
Check here if same as Assignor/Transferor: [check Box]
(If different from the Assignor/Transferor): Name and title; Doing Business As (DBA), company name; relationship, address; phone; fax; email (individual fields are editable)
Assignee/Transferee Information
Assignee/Transferee Information:
FRN [text box]
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)
Other: (check box and fill-in box)
Name and title; Doing Business As (DBA), address; phone; fax; email; attention to (imported from CORES during authentication)
Assignee/Transferee Contact Information.
Check here if same as Assignee/Transferee: (check box)
(If different from the Assignee/Transferee): Name and title; Doing Business As (DBA), company name; relationship, address; phone; fax; email; (individual fields are editable)
Additional Assignee/Transferee Contacts.
The Applicant must 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. See 47 CFR § 63.18(q)(1)(iii).
7a. 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]
7b. 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]
Identify the Government, State, or Territory under the laws of which a corporate or partnership Assignee/Transferee and Assignor/Transferor is organized.
[Drop-down menu with list of countries and states if United States is selected with the ability to add/remove]
(a) Applicant Name (the transferor/assignor and the transferee/assignee names) |
(b) Government, State, or Territory where Applicant is Organized |
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Application Information
Enter the name of the Authorization Holder(s) and AuthID(s) and associated file number(s) (ITC-LIC or ITC-MOD) of the Authorization Holder(s) subject to this transaction.
[[Draw the following table for text entry:]
(a) AuthID |
(b1) Name of Authorization Holder |
(b2) File Number of Current Authorization Holder |
Brief Description of the Transaction: (editable field)
Is this an assignment of authorization or transfer of control?
a. (check box) Assignment of authorization
b. (check box) Transfer of control
Is this a pro forma or substantive transaction?
a. (check box) Substantive
b. (check box) Pro forma
[If 11a and 12a are checked, the questions and tables in “Supplement A/Substantive Assignment” should be filled out.]
[If 11a and 12b are checked the questions and tables in “Supplement B/Pro Forma (Non-Substantive) Assignment” should be filled out.]
[If 11b and 12a are checked the questions and tables in “Supplement C/Substantive Transfer of Control” should be filled out.]
[If 11b and 12b are checked the questions and tables in “Supplement D/Pro Forma (Non-Substantive) Transfer of Control” should be filled out.]
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |