Annex F: Application Form
1800 MHz Auction
Award of frequencies in the frequency bands
1720.1-1785.0 MHz and 1815.1-1880.0 MHz
Information Memorandum
Annex E
Application Form
June 2016
Issued by
The Danish Energy Agency
Denmark
www.ens.dk
Page 4Annex F: Application Form
Annex E: Application Form
Instructions
This annex sets out instructions on how to complete the attached application form.
The application shall be in Danish and be submitted in one original copy signed by the natural persons who are empowered to sign for the bidder or who are otherwise authorised to bind the bidder. Two copies of the application shall accompany the application. The bidder is also requested to supply a non-binding English translation (one paper copy only). Bidders are also requested to provide a USB key with copies of all Danish and English documents submitted in Adobe Systems Portable Document Format (pdf).
Applications should only be submitted within the specified hours. If these matters are not complied with, the application may not be accepted.
The Application shall consist of the following documents:
Form reference / InstructionsA completed and signed application form with associated documents.
Bank guarantee for deposit.
Annex G / A copy of a Bidder Declaration prepared by the Danish Energy Agency, signed by one or more natural persons who are empowered to sign for the bidder or who are otherwise authorised to bind the bidder.
1 / This section provides a checklist of all of the documents required to accompany the application.
(1) Checklist of information and documents required to accompany the Application:
Form reference / Checklist of accompanying information and documents / Please tick1.1 / The bidder's name and an address in Denmark, telephone number and e-mail address where the bidder may be contacted on business days between 09.00 and 17.00 hours (Danish time).
1.2
Documentation to be enclosed separately / Details and documentation of the names, positions and signatures of the natural persons who are empowered to sign for the bidder or who are otherwise authorised to bind the bidder in any respect regarding the application and the auction, and documentation for the empowerment to sign or the authorisation.
1.3 / An exhaustive list of the names, positions, and addresses of the bidder's members of the board of management and board of directors or, in the absence of such, similar bodies.
1.4 / An exhaustive list of the bidder's insiders to the extent that the bidder is aware of such insiders.
2.1 / Information about whether the applicant wishes to acquire an A lot.
2.2 / Coverage area Group Bids (only required if ‘Yes’ has been answered for section 2.1).
Annex H / A detailed, clear and exhaustive outline of the ownership structure for the bidder, to the extent that the bidder is aware of such particulars, and in accordance with annex H drawn up by the Danish Energy Agency, including:
(a) a list of all connected persons and for each of them a statement to explain why the person concerned is a connected person, and if the person is a mobile operator, information to that effect,
b) a list of associated persons and for each of them a statement to explain why the person concerned is an associated person, and whether the person is also an associated person in relation to other bidders.
However, the outline does not have to state the names of persons that are connected persons in relation to a bidder exclusively as a result of the control over such legal entities by a state.
A summary of any agreement according to which one or more persons have control over the bidder to the extent that the bidder is aware of such conditions.
Evidence of any approval in accordance with clause 11 of the Danish Energy Agency’s decision.
Application Form
1.1 Name of the bidder:
Contact details (during business days between 09.00 and 17.00 Danish time):
Address:
Telephone No.:
E-mail:
1.2 Authorised persons
Name: / Position: / Signature:
Signatures of Authorised persons:
1.3 Members of the bidder's board of management and board of directorsName / Position / Personal Address
If additional space is required, please insert duplicate sheets, numbered 1.3(a), 1.3(b) etc.
Signatures of Authorised persons:
(1) Details of the bidder (contd.)
Name of insider / Role of insider
If additional space is required, please insert duplicate sheets, numbered 1.4(a), 1.4(b) etc.
Signatures of Authorised persons:
2. A lot
2.1. Interested in an A lot?
YES □
NO □
Reserve price for an A lot is DKK 50 mio.
See section 7 of the Information Memorandum for information on assignment and pricing of this lot.
2.2 Coverage Area Group Bids
Only fill in this section if answered ’Yes’ in section 2.1 above.
Please fill in bid amounts for each Coverage Area Group. See section 7 of the Information Memorandum for information on the assignement and pricing of Coverage Area Groups to winners of A lots.
Coverage Area Group / Coverage Area Group Bid Amount (in whole DKK – the bid amount can be DKK 0)1. Group 1
2. Group 2
3. Group 3
Signatures of Authorised persons:
END OF APPLICATION FORM
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