Application to renew a broadcasting licence for a Native undertaking

For Commission's use

Application number

Application to Renew a Broadcasting Licence for
a Native Undertaking

GENERAL FILING INSTRUCTIONS

Please sign and return this questionnaire to: Secretary General, Canadian Radio-television and Telecommunications Commission, Ottawa, Ontario, K1A 0N2.

1. GENERAL INFORMATION

1.1

IDENTIFICATION OF LICENSEE
NAME:
ADDRESS:
TELEPHONE:
FAX:
E-MAIL:

Please indicate the E-Mail address and FAX number that should be specified in a Public Notice.

FAX:
E-MAIL:

1.2

EXAMINATION BY THE PUBLIC

Location where application will be available for public members, if different from above:

ADDRESS:

1.3

TECHNICAL INFORMATION

LOCATION	TYPE OF UNDERTAKING	CALL SIGN	EXPIRY DATE

1.4	COMPLIANCE The undertaking is being operated in compliance with the provisions of the licence, the Broadcasting Act, and all applicable regulations of the CRTC.
		YES ( )	NO ( )
	(To be completed by the licensee) If NO, provide the full details of any non-compliance during the licence term, including the reasons, any remedial action and, where applicable, the period of time expected before the undertaking is operating in compliance.
1.5	SAME TERMS AND CONDITIONS The licensee hereby requests the renewal of its licence under the same terms and conditions as the current licence; and for native radio undertakings, as well as those stipulated in Public Notice CRTC 2001-70.
		YES ( )	NO ( )

	Information confirmed with (licensee representative): ___________________________________ Date: ___________________________________
	Name of CRTC representative: ______________________________ Tel.: ( )
	Signature of Licensee representative: _______________________________________________

This document is available in alternative format upon request. CRTC 121 (2005-10-06) - Renewal - Native Undertaking version française disponible *End of Document*