Application for Market Trials Info-communications Development Authority of Singapore 8 Temasek Boulevard #14-00 Suntec Tower Three Singapore 038988 1 INFORMATION This is an application form for approval from the Info-communications Development Authority of Singapore (IDA) to conduct Market Trials on telecommunication systems and/or services in Singapore. All sections of this application form MUST be completed. 2 The application must be made by authorised personnel only. The following information are required: (a) company/business registration documents from ACRA; and (b) technical and non-technical details of the trial. The application including supporting documents should be attention to Assistant Director-General (Telecoms) at the above address. 3 Your attention is drawn to the provisions of the Telecommunications Act Cap 323 and in particular to the provisions of Section 3, 5 AND 16. 4 Consideration for approval of this application will be based on information declared in this application. Approval of application will be at the sole discretion of IDA. 5 This application will take approximately 20 minutes to complete. Applicant Information Name (Company/Business) Contact Person Name (as in NRIC/Passport) Contact Person Designation NRIC No. Passport No. Nationality Business Registration No. (BRN) Principle Activity(ies) (as registered ACRA) Correspondence Address Billing Address (if it is different from Correspondence Address) ISO 9001:2000 Cert. No: CI/4593 Refers to mandatory fields to be completed by the applicant Version 1.0 28 July 2004 Page 1 of 4 Telephone No. Fax No. Email Pager/Handphone Number Corporate Structure Registered (include parent company, where applicable, subsidiaries and other interests of the group in Singapore and abroad, details of principal shareholders, board of directors, key personnel and management structure, to use an attachment if insufficient space) Please state any IDA telecommunication licences held (whether granted or in process of application with IDA) For clarification IDA should contact Name Address NRIC/Passport No Designation Tel No Trial Details (All questions in this section must be answered. Answers can also be provided in separate attachment to be submitted together with this application form.) (a) Objective of the proposed Trial. Refers to mandatory fields to be completed by the applicant Version 1.0 28 July 2004 Page 2 of 4 (b) Date and Period/Duration of the proposed Trial. (Must not exceed 6 months.) (c) Describe in detail the role, identities and numbers of the parties involved in the proposed trial i.e., terminal equipment supplier/manufacturer, network operator/service provider, etc. (d) Describe in detail the scope and features of the proposed Trial, and the services provided including the technical/commercial parameters to be tested. (Description should include the estimated number of trial participants, any particular target end-user group, the service schemes to be offered and the operation of the proposed services.) (e) Describe in detail the system configuration to be used in the trial, including any interconnection with the Public Switched Telephone Network (PSTN) and/or any other networks authorised by IDA. (Where applicable, please provide a schematic diagram to aid the illustration of your interconnection arrangements.) (f) Radio Spectrum Requirement (Please provide details of the radio spectrum required for the trial.) Refers to mandatory fields to be completed by the applicant Version 1.0 28 July 2004 Page 3 of 4 (g) Describe in detail the location and geographic coverage of the proposed Trial. (Please attach a map for illustration purposes where applicable.) (h) Declare whether there is any collection of monetary deposits and/or use of prepaid cards for collection of payments from their customers (other than credit cards) (If yes, please provide details of the scheme and a letter of intent from a bank on the issuance of a Banker’s Guarantee of S$100,000, or an amount equivalent to the total face value of the prepaid cards or total value of the monetary deposits the trial licensee intends to issue/collect, whichever is lower, to IDA within 14 days upon grant of application.) You are required to also submit online the radio-communication station/network licence at “tls.ida.gov.sg” if the Market Trial to be conducted requires the radio spectrum to be assigned. I declare that all the information in this registration form is true and correct. I understand that approval from the Info-communications Development Authority of Singapore for this application is based on the information as declared in this application. Should this information be incorrect, any approval granted by the Authority will be withdrawn. I have seen the guidelines and the licence conditions for conduct of Market Trials and agreed to abide by them. I understand that if there is any variation from the terms and conditions, the Authority reserves the right to withdraw the approval and require the Market Trial to be terminated. Name/Signature Date/Company Stamp Refers to mandatory fields to be completed by the applicant Version 1.0 28 July 2004 Page 4 of 4
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