Appendix C

Sample form only: do not complete

This form is for reference purposes only. It is not to be completed in this format.

To complete this and submit it to the CRTC, download the form.


Information on the regional terrestrial BDU licence
Undertaking (service area) to be deleted from the regional licence Number of subscribers* Criteria for deleting an undertaking from the regional licence (must meet at least one of the criteria**)
Separate head end facilities (provide geographical coordinates) Unique local/regional TV stations as part of the basic service

(Provide TV stations)
Offer programming on a community channel


**Please refer to paragraphs 62 to 78 of Broadcasting Order CRTC 2009-544 for additional details regarding the criteria.

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