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.
|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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