ITC-ASG-TC Part B Pro Forma Assignment REV to OMD March 21 2024

DRAFT – March 2024

ITC-ASG/TC Part B: Pro Forma (Non-Substantive) Assignment

13. Is the Assignment of the authorization:

• Voluntary (check box)

• Involuntary (check box)

13.a. If involuntary, identify the type below:

• A bankruptcy trustee appointed under involuntary bankruptcy

(check box)

• An independent receiver appointed by a court of competent jurisdiction in a foreclosure action

(check box)

• Or, in the case of death or legal disability, to a person or entity legally qualified to succeed the deceased or disabled person under the laws of the place having jurisdiction over the estate involved

(check box)

• Other (check box) If “Other,” identify the type: [text box]

13.b. Date of event causing the involuntary assignment:

[Field for date] [If date entered is prior to 30 days before current date] You must submit in an attachment an explanation as to why the filing was not provided to the Commission no later than thirty days (30) or less after the event causing the involuntary assignment in accordance with section 63.24(g) of the Commission’s rules.

Related Filings

13. Is there a separately filed Application(s) related to this transaction filed by the Applicants?

• Yes (check box)

If yes, enter below the IBFS File No(s), ULS File No(s) and Docket No(s) for the related filings.

IBFS: [fill-in box]

ULS: [fill-in box]

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

• No (check box)

Transaction Information

13. Provide the consummation date of the transaction.

[Field for date] [If date entered is prior to 30 days before current date,] You must submit in an attachment an explanation as to why the notification was not provided to the Commission no later than thirty days (30) or less after the consummation in accordance with section 63.24(f) of the Commission’s rules.

13. The Assignee certifies that the assignment or transfer of control was pro forma, as defined in section 63.24 of the Commission’s rules, and together with all previous pro forma transactions, does not result in a change of the authorization holder’s ultimate control. In an attachment, provide an explanation for this certification.

(check box)

13. Enter the AuthID(s)/file number(s) of the international section 214 authorization(s) for which the Assignee seeks consent to assign:

(a)

List of Authorizations

13. Is this a partial assignment of assets?

• Yes (check box)

• No (check box)

13. Identify the ownership interest(s) that the Assignor will retain in the international section 214 authorization.

[fill-in box]

13. Is the Assignee seeking to obtain an international section 214 authorization through this filing?

• Yes (check box) [If yes] The Assignee does not currently hold an international section 214 authorization.

• No (check box) [If No]

  • The Assignee currently holds an international section 214 authorization.

  • Provide the AuthID(s)/ITC-214, ITC-MOD file number(s) held by the Assignee below.

ICFS: [fill-in box]

Foreign Ownership

13. Does any individual or entity that is not a U.S. citizen hold a 10% or greater direct or indirect equity or voting interest, or a controlling interest, in the Assignee?

• Yes (check box)

• No (check box)

Ownership Information

13. Will any person or entity have a 10% or greater direct or indirect ownership of the Authorization Holder?

• Yes (check box) Provide, in the fields below, the name, address, citizenship, and principal business of any person or entity that directly or indirectly owns at least 10% of the equity and/or voting interest or a controlling interest of the Authorization Holder (“interest holder”) and the percentage of equity and/or voting interests owned by each of those entities to the nearest 1%. Also provide, in an attachment, a detailed ownership listing responding to 63.18(h) of the Commission’s rules.”

(a) Name of Individual or Entity that Directly or Indirectly Owns at Least 10% of the Equity and/or Voting Interests of Applicant or has a controlling interest (“Interest Holder”)	(b) Address of Interest Holder	(c) Citizenship or Country of Incorporation of Interest Holder	(d) Principal Business of Interest Holder	(e) Name of entity in which Interest Holder Has at Least 10% Ownership Interest. (Indicate Direct or Indirect Interest).	(f) Percentage Owned by Interest Holder (indicate the equity interests)	(g) Percentage Owned by Interest Holder (indicate the voting interests)
[fill-in box]	[fill-in box]	[Drop-down menu of countries]	[fill-in box]	[fill-in box] [cannot be less than 10 or greater than 100]	[fill-in box]	[fill-in box]

[Ability to add/remove rows]

• No (check box)

13. Will the Authorization Holder have any interlocking directorates with a foreign carrier, pursuant to section 63.18(h) of the Commission’s rules?

• Yes (check box) [If yes,] In an attachment identify the interlocking directorates pursuant to section 63.18(h) of the Commission’s rules.

• No (check box)

Foreign Carrier Affiliations

13. Is the Applicant a foreign carrier or affiliated with a foreign carrier as defined in sections 63.09(d) and (e) of the Commission’s rules?

• Yes [check box] Complete the table below and, in an attachment, provide the information and certifications required by section 63.18(i) through (m) of the Commission’s rules.

• No [check box] In an attachment, provide the information and certifications required by 47 CFR § 63.18(i) through (m).

24.a. [If Q 24 is Yes] Provide the affiliation information below:

For column (c)1, choose from one of the following options: (a) The Applicant is a foreign carrier in that country; (b) The Applicant controls a foreign carrier in that country; (c) Any entity that owns more than 25% of the Applicant, or that controls the Applicant, controls a foreign carrier in that country; (d) Two or more foreign carriers (or parties that control foreign carriers) own, in the aggregate, more than 25 percent of the Applicant and are parties to, or the beneficiaries of, a contractual relation (e.g., a joint venture or market alliance) affecting the provision or marketing of international basic telecommunications services in the United States; or (e) the country is a member of the World Trade Organization (WTO).

(a) Name of Foreign Carrier	(b) Country of Affiliation	(c)(1) Identify the Type of Affiliation	(c)(2) Explanation for Non-standard Affiliation	(d) Does the Applicant seek to provide international telecommunications service to this country?	(e) Is this country a member of the World Trade Organization?
[fill-in box]	[drop-down menu of countries] [ability to select “other non-specified areas,” which must be identified in an uploaded attachment]	[Text box with these options] • (a) The Applicant is a foreign carrier in that country; or •(b) The Applicant controls a foreign carrier in that country; or •(c) Any entity that owns more than 25% of the Applicant, or that controls the Applicant, controls a foreign carrier in that country. • (d) Two or more foreign carriers (or parties that control foreign carriers) own, in the aggregate, more than 25 percent of the Applicant and are parties to, or the beneficiaries of, a contractual relation (e.g., a joint venture or market alliance) affecting the provision or marketing of international basic telecommunications services in the United States. •(e) N/A [text box for explanation]	[fill-in box if choice in column (c)(1) was e]	[Yes/No radial buttons]	[Yes/No radial buttons]

[Ability to add/remove rows from this table]

24.b. [Display if answer to Q26 is Yes]] Does the Applicant seek to be classified as non-dominant on any route listed in the application pursuant to section 63.10 of the Commission’s rules?

• Yes (check box) [If Yes, display Qs 26.c and 26.d] The Applicant must provide in an attachment information to demonstrate that it qualifies for non-dominant classification under section 63.10 of the Commission’s rules.

• No [Show Q26.e]

24.c. Identify the routes for which the Applicant is requesting to be classified as a “non-dominant” carrier.

[Drop-down menu of countries]

24.d. Has the Applicant uploaded an attachment providing information to demonstrate that it qualifies for non-dominant classification under section 63.10 of the Commission’s rules?

• Yes (check box)

• No (check box)

24.e The Applicant agrees to the requirements of section 63.10(c), (d) & (e) for the following routes:

[Drop-down menu of countries]

13. Has the Applicant uploaded an attachment providing the information and certifications required by section 63.18(i) through (m) of the Commission’s rules?

• Yes [Check Box]

• No [Check Box]

Waivers

13. Does the Applicant request a waiver(s) of the Commission’s rules?

• Yes (check box) Attach the request with a supporting narrative and documentation.

• No (check box) 

 

26a.  If yes, Identify the rule section(s) for which a waiver is sought below. 

[fill-in box]

Application Fees

13. Will a fee be paid?

• Yes (check box)

• No (check box)

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

[[Add drop Down box to select fee code]] 

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

• Governmental Entity (check box) 

• Noncommercial educational license (check box) 

• Other [fill-in text box for explanation]

Attachments:

13. The Applicant has uploaded an attachment describing the transaction and explaining how it meets the Commission’s rules and that this transaction is in the public interest. (check box)

13. The Assignee uploaded an explanation for its certification that the assignment or transfer of control was pro forma, as defined in section 63.24 of the Commission’s rules, and together with all previous pro forma transactions, does not result in a change of the authorization holder’s ultimate control. (check box)

13. The Applicant has uploaded an explanation as to why the pro forma notification was not provided to the Commission no later than thirty days (30) or less after the consummation in accordance with section 63.24(f) of the Commission’s rules.

• Yes (check box)

• N/A (check box)

13. The Applicant has uploaded an attachment to provide a detailed ownership listing responding to section 63.18(h) of the Commission’s rules. Yes (check box)

• N/A (check box)

13. The Applicant has uploaded an attachment identifying any interlocking directorates with a foreign carrier, pursuant to section 63.18(h) of the Commission’s rules.

• Yes (check box)

• N/A (check box)

13. The Assignee has uploaded must information to demonstrate that it qualifies for non-dominant classification under section 63.10 of the Commission’s rules.

• Yes (check box)

• N/A (check box)

13. The Applicant has uploaded a statement supporting its waiver request and identifying the rule number(s) involved, along with other material information.

• Yes (check box)

• N/A (check box)

Attachment/Confidential Treatment of Attachments

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

• Yes (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.

1. No (check box)

Attachment No.	Description of Attachment	Confidential Treatment Requested
Attachment 1	[Fill-in box]	[check box]
Attachment (Public Version of Confidential Treatment Request and Supporting Statement)	[Fill-in box]
Attachment 2(a) (Public Redacted Version)	[Fill-in box]
Attachment 2(b) (Confidential Non-Redacted Version)	[Fill-in box]	[check box]

Certification and Acknowledgement Statements

13. In submitting this form,

• The Assignee certifies that for any country in which the Assignee affiliated with a foreign carrier as defined in section 63.09(d) and (e) of the Commission’s rules that is not a member of the World Trade Organization, it has demonstrated in an attachment whether the foreign carrier has market power or lacks market power under the criteria in section 63.10(a) of the Commission’s rules.

• The Assignee 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.

• The Assignee will designate an agent for service in the District of Columbia if required by section 413 of the Communications Act within 30 days of providing service.

• The Assignee certifies that it has provided, in an attachment, a narrative description of the transaction, provided all the required information and certifications, and a complete statement setting forth the facts that show how the assignment or transfer will serve the public interest, as required under section 214 of the Communications Act and sections 63.18 and 63.24 of the Commission’s rules.

• 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 Assignee 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.

(check box)

National Security/Law Enforcement Certification Statements

13. In submitting this form, the Applicant 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)

Parties Authorized to Sign

13. Authorization Holder Signature

First Name:	MI:	Last Name:		Suffix:
Title:
Signature:			Date:
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)

13. Assignor Signature

First Name:	MI:	Last Name:		Suffix:
Title:
Signature:			Date:
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 35, AND/OR FORFEITURE (U.S. Code, Title 47, Section 503)

13. Assignee Signature

First Name:	MI:	Last Name:		Suffix:
Title:
Signature:			Date:
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 35, AND/OR FORFEITURE (U.S. Code, Title 47, Section 503)

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