Application form

Allocation of residual spectrum (2.3 GHz Band)

This application form has been approved pursuant to paragraph 2.3 (a) of the Radiocommunications (Allocation of Spectrum Licences by Auction or Predetermined Price) Determination 2006.

ACMA form – R137Page 1 of 7January 2009

Before completing this Form, ensure you understand the conditions under which spectrum licences are being allocated. You should understand the provisions contained in:

  • the Radiocommunications Spectrum Marketing Plan (2.3 GHz Band) 2009 and associated legislative instruments regarding interference management;
  • the Radiocommunications (Allocation of Spectrum Licences by Auction or Predetermined Price) Determination 2006 (the ‘Allocation Determination’); and
  • the Radiocommunications Act 1992.

It is in your interest to read the Applicant Information Package and seek independent legal, financial and engineering advice before

deciding to apply for these licences.

Disclosure of information

Under Part 7A of the Australian Communications and Media Authority Act 2005, ACMA is permitted to share information with certain specified government entities. Such information may include commercially sensitive information.

Potential applicants should seek independent advice regarding the applicant’s information that may be disclosed.

Subsection 3.4(7) of the Allocation Determination provides that ACMA may publish the name of a registered applicant and the licences for which the applicant is eligible to bid before the start of an auction.

A spectrum licensee’s name and other details will be made available on ACMA’s Register of Radiocommunications Licences.

ACMA form – R137Page 1 of 7January 2009

Instructions for completion

ACMA form – R137Page 1 of 7January 2009

The completed application form, and:

  • the completed Deed of Acknowledgment: and
  • the entry fee and deposit;

MUST be received at ACMA by no later than11.00 am on the advertised closing date for applications.

Payments may be made by bank cheque or bank transfer (see section 2.5 of the Allocation Determination for details).

Wheretolodgethisform

ACMA form – R137Page 1 of 7January 2009

ACMA street address:

Operations Branch —2.3 GHz Allocation

Australian Communications and Media Authority

Purple Building

Benjamin Offices

Chan Street

BELCONNEN ACT 2617

ACMA postal address:

Operations Branch —2.3 GHz Allocation

Australian Communications and Media Authority

PO Box 78

BELCONNENACT 2616

ACMA form – R137Page 1 of 7January 2009

Enquiries may be directed to Radiocommunications Licensing & Telecommunications DeploymentSection on:

  • Telephone1300 850 115
  • Fax (02) 6219 5347

How to complete the application form

These instructions are cross-referenced to each section of the form. Relevant details must be completed before the form can be accepted. Use of block letters will assist legibility.

A.INSERT the FULL NAME(s) of each person who wishes to make an application. For an application in joint names, all names must be shown and each party to the application must sign. An application by a company must be executed in accordance with section 127 of the Corporations Act 2001. If the Applicant is not incorporated, the application must be in the name(s) of an individual(s). ACMA can only issue spectrum licences to either an individual or body corporate. For example, if the Applicant is an unincorporated entity, at least one individual office bearer must sign this form as the Applicant. In the case of a trust, at least one trustee must sign this form as the Applicant. At least one full name is required for each individual. If two or more persons wish to make a joint application, tick the appropriate box and provide full name and address details on an attached sheet of paper. Where the Applicant has a registered office, the address of the registered office should be used.

INSERT Australian Business Number (ABN), Australian Company Number (ACN) or Australian Registered Business Number (ARBN) as appropriate.

Note: Information in this question may be provided to other applicants and to the Australian Competition and Consumer Commission (ACCC).

B.INSERT the trading name of the business (if any).

Note: Information in this question may be provided to other applicants and to the ACCC.

C.INSERT the details of the person to whom inquiries and correspondence should be directed as well as a second person who can be contacted if your principal contact person is unavailable. All contact details requested should be provided if possible.

D.Enter ‘yes’ against the licences you wish to apply for in Column 6.

Example 1

In the table below the Applicant has applied for a 35 MHz lot in the Darwin area and a 35 MHzlot in the Geraldton area.

Column 1 / Column 2 / Column 3 / Column 4 / Column 5 / Column 6
Lot / Lower Frequency / Upper Frequency / Reserve Price / Available Bandwidth (MHz) / Licences applied for (Enter ‘Yes’ for licences you wish to apply for)
Darwin (2) / 2365 / 2400 / $17,755 / 35 / Yes
Geraldton (2) / 2302 / 2337 / $7,576 / 35 / Yes

Example 2

In the table below the deposit calculations are based on the licences applied for in example 1 above.

Lot / Lower Band
(MHz) / Upper Band
(MHz) / Reserve Price / Available Bandwidth (MHz) / Licences applied for (Enter ‘Yes’ for licences you wish to apply for) / Deposit
Darwin (3) / 2365 / 2400 / $17,755 / 35 / Yes / $1,775.45
Geraldton (2) / 2302 / 2337 / $7,576 / 35 / Yes / $757.63
Total Deposit / $2,533.08

E.In the space provided insert the total deposit you are required to pay.

F.The entry fee is $1000.00. It will not be waived and is not refundable.

G.Calculate total payment required by adding the total deposit in box E to the entry fee at box F. Enter the result in box G.

H.SIGN or EXECUTE the Form. If executed by a company this must be in accordance with section 127 of the Corporations Act 2001 and the company’s constitution. Joint Applicants must all sign or execute the form. If there is insufficient space, please sign or execute as appropriate on an attached sheet of paper.

I.DATE the form.

Remember you should keep a copy of all completed forms.

A. Full name and address of applicant

ACMA form – R137Page 1 of 7January 2009

Answers to question A will be provided to other applicants and to the ACCC.

ACMA client number (if known)

Organisation name (not for individuals)

Name (if not an organisation)

SURNAME
GIVEN NAMES
TITLE MR / MRS / MS / DR / Other

Street address or registered office

SUBURB STATE
POSTCODE COUNTRY

Company ABN, ACN or ARBN (if applicable)

ACMA form – R137Page 1 of 7January 2009

( )This is a joint application. Details of the other applicants are on the attached sheet of paper.

(If this applies, tick the box above and set out the full name and address details of any other parties on a separate sheet of paper. The paper should be marked clearly “Question A” and with the name of the person applying and whose name appears above).

B. Trading name (if any) of applicant

ACMA form – R137Page 1 of 7January 2009

ACMA form – R137Page 1 of 7January 2009

Answers to question B will be provided to other applicants and to the ACCC, if requested by these third parties.

C. Contact details

ACMA form – R137Page 1 of 7January 2009

Principal contact person

Name

SURNAME
GIVEN NAMES
TITLE MR / MRS / MS / DR / Other

Position in relation to the applicant

Street address

SUBURB STATE
POSTCODE COUNTRY

Contact details

WORK ( )
HOME ( )
MOBILE
FACSIMILE ( )
EMAIL

Second contact person

Name

SURNAME
GIVEN NAMES
TITLE MR / MRS / MS / DR / Other

Position in relation to the applicant

Street address

SUBURB STATE
POSTCODE COUNTRY

Contact details

WORK( )
HOME( )
MOBILE
FACSIMILE ( )
EMAIL

ACMA form – R137Page 1 of 7January 2009

D. Nominate the licences you wish to apply for

ACMA form – R137Page 1 of 7January 2009

Column 1 / Colum 2 / Column 3 / Column 4 / Column 5 / Column 6 / Column 7
Lots Nos / Lower Frequency (MHz) / Upper Frequency (MHz) / Reserve Price / Available Bandwidth (MHz) / Licences applied for (Enter ‘Yes’) / Deposit
Darwin (1) / 2337 / 2365 / $14,204 / 28 / $1,420.36
Darwin (2) / 2302 / 2337 / $17,755 / 35 / $1,775.45
Darwin (3) / 2365 / 2400 / $17,755 / 35 / $1,775.45
Geraldton (1) / 2337 / 2365 / $6,061 / 28 / $606.10
Geraldton (2) / 2302 / 2337 / $7,576 / 35 / $757.63
Geraldton (3) / 2365 / 2400 / $7,576 / 35 / $757.63
Kalgoorlie (1) / 2337 / 2365 / $6,819 / 28 / $681.91
Kalgoorlie (2) / 2302 / 2337 / $8,524 / 35 / $852.39
Kalgoorlie (3) / 2365 / 2400 / $8,524 / 35 / $852.39
Roxby Downs (1) / 2337 / 2365 / $828 / 28 / $82.77
Roxby Downs (2) / 2302 / 2337 / $1,035 / 35 / $103.46
Roxby Downs (3) / 2365 / 2400 / $1,035 / 35 / $103.46
South-West Western Australia (1) / 2337 / 2365 / $40,081 / 28 / $4,008.08
South-West Western Australia (2) / 2302 / 2337 / $50,101 / 35 / $5,010.10
South-West Western Australia (3) / 2365 / 2400 / $50,101 / 35 / $5,010.10
Telfer Mine (1) / 2309 / 2316 / $5 / 7 / $0.54
Telfer Mine (2) / 2323 / 2330 / $5 / 7 / $0.54
Telfer Mine (3) / 2337 / 2358 / $16 / 21 / $1.61
Telfer Mine (4) / 2365 / 2372 / $5 / 7 / $0.54
Telfer Mine (5) / 2379 / 2400 / $16 / 21 / $1.61
Western New South Wales / Bourke (1) / 2337 / 2365 / $4,193 / 28 / $419.33
Western New South Wales / Bourke (2) / 2302 / 2337 / $5,242 / 35 / $524.16
Mid West Radio Quiet Zone (1) / 2337 / 2365 / $102 / 28 / $10.17
Mid West Radio Quiet Zone (2) / 2302 / 2337 / $127 / 35 / $12.71
Mid West Radio Quiet Zone (3) / 2365 / 2400 / $127 / 35 / $12.71
Gascoyne/Pilbara (1) / 2337 / 2365 / $6,932 / 28 / $693.25
Gascoyne/Pilbara (2) / 2302 / 2337 / $8,666 / 35 / $866.56
Gascoyne/Pilbara (3) / 2365 / 2400 / $8,666 / 35 / $866.56
The Kimberley (1) / 2337 / 2365 / $2,956 / 28 / $295.63
The Kimberley (2) / 2302 / 2337 / $3,695 / 35 / $369.54
The Goldfields (1) / 2337 / 2365 / $133 / 28 / $13.27
The Goldfields (2) / 2302 / 2337 / $166 / 35 / $16.59
The Goldfields (3) / 2365 / 2400 / $166 / 35 / $16.59
Northern Territory (1) / 2337 / 2365 / $1,530 / 28 / $153.01
Northern Territory (2) / 2302 / 2337 / $1,913 / 35 / $191.26
Northern Territory (3) / 2365 / 2400 / $1,913 / 35 / $191.26
South Australia (1) / 2337 / 2365 / $1,488 / 28 / $148.83
South Australia (2) / 2302 / 2337 / $1,860 / 35 / $186.04
South Australia (3) / 2365 / 2400 / $1,860 / 35 / $186.04
North Queensland (1) / 2337 / 2365 / $6,749 / 28 / $674.94
North Queensland (2) / 2302 / 2337 / $8,437 / 35 / $843.67
North Queensland (3) / 2365 / 2400 / $8,437 / 35 / $843.67
Central Queensland (1) / 2337 / 2365 / $2,750 / 28 / $274.95
Central Queensland (2) / 2302 / 2337 / $3,437 / 35 / $343.69
Central Queensland (3) / 2365 / 2400 / $3,437 / 35 / $343.69
Cameron Corner (1) / 2337 / 2365 / $2,196 / 28 / $219.60
Cameron Corner (2) / 2302 / 2337 / $2,745 / 35 / $274.50
Cameron Corner (3) / 2365 / 2400 / $2,745 / 35 / $274.50

Note 1: Licence expiry will be 24 July 2015.

Note 2: The range of numbers that identify a frequency range include the higher, but not the lower number.

E. Deposit

ACMA form – R137Page 1 of 7January 2009

Calculate the deposit required for the licences you have applied for and enter the total deposit here. The deposit is 10% of the reserve price for the licences applied for in Item D above.

$

Total deposit required:

E. Deposit

F. Entry fee

ACMA form – R137Page 1 of 7January 2009

$1000.00

Entry fee required:E. Deposit

G. Total payment required

ACMA form – R137Page 1 of 7January 2009

$

Total payment required (items E & F):E. Deposit

A bank cheque for the amount at Item G must be made to the ‘‘Australian Communications and Media Authority’ and crossed ‘Not Negotiable’ and must be received by ACMA by the closing date for applications and is toaccompany this Application Form. Alternative arrangements for payment to ACMA’s bank account by bank transfer may be made (section 2.5 (5) of the Allocation Determination).

All payments made by bank transfer should be made to the following bank account:

  • Bank – Australia and New Zealand Banking Group Limited;
  • Branch – Belconnen;
  • BSB number – 012-951
  • Account number – 837924272;
  • Account name – ACMA Official Administered Receipts Account;
  • Early payment is recommended to allow time for the ACMA to resolve payment issues, should they arise. Applications and payments will not be accepted after the closing date and time;
  • For Overseas Payments the SWIFT CODE is ANZBAU3M;
  • Please fax your remittance advice to (02) 6219 5264 or email ; and
  • Please be sure to include in your remittance advice your client number and any reference number.

ACMA form – R137Page 1 of 7January 2009

ACMA form – R137Page 1 of 7January 2009

H. Applicant’s signature

The details provided in this form and in the attached supplementary sheets are true and correct in every detail.

EXECUTED AS A DEED

Signed, sealed and delivered by:

PRINT NAME OF APPLICANT / SIGNATURE OF APPLICANT

If two or more persons are applying jointly, please PROVIDE ALL signatures.

Signed in the presence of:

PRINT NAME OF WITNESS / SIGNATURE OF WITNESS

Witness address

OR, if the applicant is a company:

EXECUTED AS A DEED

Signed, sealed and delivered on behalf of:

PRINT NAME OF COMPANY

Print ABN, ACN or ARBN

by authority of the directors

PRINT NAME OF DIRECTOR / SIGNATURE OF DIRECTOR
PRINT NAME OF DIRECTOR / SECRETARY / SIGNATURE OF DIRECTOR / SECRETARY

If two or more companies are applying jointly, all the companies must execute in the same form on an attached piece of paper.

OR, in any other case, (e.g. incorporated association or statutory authority), please execute in the appropriate manner.

I. Date

/ /2011

ACMA form – R137Page 1 of 7January 2009