Template of the Basic International Telecommunications Services (BITS) Affidavit

SAMPLE

AFFIDAVIT

I, __________________ (individual's name), OF THE __________________ (City/Town, etc.)
of __________________ (name) in the __________________ (Province/Territory/State, etc.)
of __________________ (name) in the country of __________________ (Country)

MAKE OATH AND SAY / SOLEMNLY AFFIRM AS FOLLOWS:

1. I have personal knowledge of the matters hereinafter deposed to and I believe the same to be true.

2. As of the date of this Affidavit, I am an officer of the applicant with the title
of __________________ (corporate title) / legal counsel to the applicant.

3. The applicant is a company incorporated __________________ (insert date of incorporation), under the laws
of __________________ (insert jurisdiction of incorporation: Province/ Territory/ State/ Country, etc.).

4. The legal name of the applicant is: ____________________________________

5. The applicant operates as a telecommunications services provider under the following brand / trade name(s):
(complete if applicable)
___________________________________________________________________________

6. The address of the applicant is:
___________________________________________________________________________
___________________________________________________________________________

7. The applicant intends to manage or operate or resell or convert from analog to digital (or vice-versa) telecommunications service traffic between Canada and another country.

8. Pursuant to section 16.4 (2) of the Telecommunications Act, the applicant consents to the revocation of any Basic International Telecommunications Services licence previously issued to it, upon the issuance of the licence requested in this application.

SWORN/SOLEMNLY AFFIRMED BEFORE ME

____________________________________
a Notary etc.
a Commissioner etc. (Canada only)

Date modified:

2014-12-16