Form 300 – Administrative application (excluding technical amendments) – Radio (or Television or Distribution)

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 form online and submit it to the CRTC, log in to My CRTC Account via the Broadcasting Online Form and Cover Page.

1. General information

This application form is only to be used for applications that do not require a public process and that the Commission will deal with using the administrative approach. You may consult Broadcasting Information Bulletin CRTC 2010-960 for additional information. These applications do not fall under the Rules of Procedure with the exception of the confidentiality rules. The following applications may be subject to another process if they raise concerns.

Applicants that have any questions related to this application form may contact a Commission specialist at 1-866-781-1911.

Important notice: The Commission will return the application if it has not been duly completed. The onus will be on the applicant to submit a complete application that provides all of the relevant information, identifies all regulatory issues raised in the application and provides supporting documentation.

Electronic copy

* Submit a website address or email address where an electronic copy of the application may be requested:

Website (www.mycompany.com):

E-mail (yourname@yourdomain.com):

All information with an * is required.

1.1 Type of application

*Select the type of application you wish to submit:

Distribution:

*Select the type of application you wish to submit:

  1. Application for the extension of a deadline for the implementation of an authority to provide a new service. ( )
  2. Application by a licensee to revoke its licence. ( )
  3. Application for changes to the authorized areas of licensed broadcasting distribution undertakings (BDU). ( )
  4. Other ( )
    *Please Specify:

*Select the type of undertaking:

Cable (Terrestrial) ( )
IPTV (Terrestrial) ( )
RDU (Radiocommunication) ( )
SRDU (Radiocommunication) ( )
DTH (Satellite) ( )
Other ( )
*Please specify:

*Are you applying for a change to the authorized service area?

Yes ( )
No

*If yes, do you confirm that all priority programming services will be offered in the proposed service area as stated in the Broadcasting Distribution Regulations?

Yes ( )
No

Radio

*Select the type of application you wish to submit:

  1. Application for the extension of a deadline for the implementation of an authority to provide a new service. ( )
  2. Application by a licensee to revoke its licence. ( )
  3. Application to delete rebroadcasting transmitter(s). ( )
    • *Enter call sign or name of service to be deleted:
  4. Other ( )
    • *Please Specify:

*Select the type of undertaking:

AM ( )
FM ( )
Specialty FM Format ( )

*Is this application to change or amend your format’s condition of licence?

Yes ( )
No ( )
Other ( )
*Please specify:

*Select the sub-type of undertaking:

Commercial ( )
Campus/Community ( )
Native ( )
Other ( )
*Please specify:

Television

*Select the type of application you wish to submit:

  1. Application for the extension of a deadline for the implementation of an authority to provide a new service. ( )
  2. Application by a licensee to revoke its licence. ( )
  3. Application to delete rebroadcasting transmitter(s). ( )
    • *Enter call sign or name of service to be deleted:
  4. Other
    • *Please specify:

*Select the type of undertaking:

Conventional ( )
Discretionary (formerly Category A and B pay and specialty services) ( )
On-Demand (formerly pay-per-view and video-on-demand) ( )
Satellite-to-cable ( )
Other
*Please specify:

1.2.Identification of applicant

*Select the type of applicant:

Corporation ( ) Other ( ) Specify: ____________

* Name of legal entity who is authorized by the Commission to operate this undertaking:
* Call sign or name of service:
* Address:
* City/Town:
* Province/Territory:
* Postal code (A1A 1A1):
* Telephone (999-999-9999):
Facsimile:

1.3 Contact person representing the applicant (if there is no designated representative under 1.5)

*Name:
*Title:
*Email (yourname@yourdomain.com):
*Telephone (999-999-9999):

1.4 Sent by

*Name:
*Telephone (999-999-9999): ext:
*Email (yourname@yourdomain.com):

1.5 Designated representative

*Is there a designated representative?

Yes ( ) No ( )

I, _________________________, the applicant, hereby designate _____________________ as my representative for and on my behalf and in my name to sign, file and complete (if necessary) an application with the Canadian Radio-television and Telecommunications Commission and to sign and file a reply with respect thereto and I do hereby ratify, confirm, and adopt as my own act, such application and all replies made thereto.

*Applicant Name:
*Designated Representative:
*Signature date:
*Date (yyyy-mm-dd):
*At: (Example: city, province)
*Address of designated representative:
*Title:
*Telephone (999-999-9999):
Facsimile (999-999-9999):
*Email (yourname@yourdomain.com):

1.6 Declaration of the applicant or its designated representative

I, * ___________________________________ solemnly declare that:

  1. I am the designated representative of the applicant named in this application and as such have knowledge of all matters declared therein.
  2. The statements made in this application, or any document filed pursuant to any request for further information by the Commission, are (will be) to the best of my knowledge and belief true in all respects.
  3. The opinions and estimates given in this application, or any document filed pursuant to any request for further information by the Commission, are (will be) based on facts as known to me.
  4. I have examined the provisions of the Broadcasting Act, the broadcasting regulations and policies relevant to this application.

*Name:
*Signature date:
*Date (yyyy-mm-dd):

Witnessed by

* Name:
*Signature date:
*Date (yyyy-mm-dd):
*At: (Example: city, province)

2. Description of application

  1. *Are you requesting that your licence be revoked?
    • Yes (  ) No (  )
    • If yes, you must answer question b)
    • If no, proceed to question f)
  2. *Do you believe you are eligible for an exemption order?
    • Yes (  ) No (  )
    • If yes, you must answer question c) and d)
    • If no, proceed to question f)
  3. Please specify the exemption order that applies to your service:
  4. Certain exemption orders require that you file specific information with the Commission when requesting a revocation or when ready to commence operations. (refer to Form 147 – Registration form for exempt terrestrial BDUs entering a market served by a licensed BDU, Form 151 – Registration for exempt low-power tourist information undertakings or Form 308 – Registration for exemption of a discretionary programming undertaking (television)) Is such information required as per the exemption order you have identified?
    • Yes (  ) No (  )
    • If yes, you must answer question e) and then proceed to section 3
    • If no, proceed to section 3
  5. Please provide the information required in the exemption order:
  6. Please provide a description of your application:
  7. Provide the rationale for the proposed amendment(s) including a clear and concise statement of the relevant facts as well as the grounds of the application:
  8. Provide the nature of the decision sought:
  9. Please provide the CRTC decision number of the decision that:
    1. Imposed the deadline for which you are asking an extension; or
    2. Most recently approved the authorized area of a BDU; or
    3. Most recently renewed the licence of the station/service (or issued the licence if in the first term)

3. Request for documents to be designated as confidential

Sections 30 to 34 of the Implementation of new Rules of Practice and Procedure, Broadcasting and Telecom Regulatory Policy CRTC 2010-958, set out a process by which parties to Commission proceedings may file information on the record of a public proceeding in confidence.

A party filing information can “designate” it as confidential at the time it is filed with the Commission (section 31) if it falls into one of the following categories:

  1. Information that is a trade secret;
  2. Financial, commercial, scientific or technical information that is confidential and that is treated consistently in a confidential manner by the person who submitted it; or
  3. Information the disclosure of which could reasonably be expected
    1. To result in material financial loss or gain to any person;
    2. To prejudice the competitive position of any person; or
    3. To affect contractual or other negotiations of any person.

At the time that the party files the information it designates as confidential, it must provide an abridged version of the document along with an explanation of how the information falls into a category of information listed in section 31. The party must provide a detailed rationale to explain why the disclosure of the information is not in the public interest (section 32(1)).

The confidential version of the document must be filed separately and must be marked "CONFIDENTIAL" on each page. If the document is filed electronically, each file containing confidential information must include "confidential" in the file name.

The abridged version of the document and the reasons for the designation of information as confidential will be placed on the public record of the proceeding.

Please consult the Procedures for filing confidential information and requesting its disclosure in Commission proceedings, Broadcasting and Telecom Information Bulletin CRTC 2010-961 for complete process for filing confidential information.

*Are you requesting for some information to be designated as confidential?

Yes ( ) No ( )

*If yes, provide a detailed rationale to explain why the disclosure of the information is not in the public interest:

4. Documents to be appended to the application and naming convention of electronic documents

Documents should be submitted in an accessible format (Broadcasting and Telecom Information Bulletin CRTC 2015-242)

The following documents should be submitted as separate electronic documents using the naming convention specified below. The document number (Doc#) indicates the ascending order in which the documents should appear on the public file.

The document name should not exceed 100 characters or include any special characters (%, $, &, /, (), #, etc).
The document should not be submitted in .xhtml format.

Document Electronic file name Appended Confidential
Appendix A Doc1 – Service area map  
Additional documents (if necessary) Doc#- “Specify name of document”  
Each confidential document NOT WEB - Doc# - CONFDOC - "brief description of the document"  
Abridged version of each confidential document Doc# - ABRIDGED VERSION - "same description of document for which confidentiality is requested"  

CRTC 300 (2019-10-11) – Administrative application (excluding technical amendments) – Radio (or Television or Distribution)

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