The Legal Alliance

Schedule II - Application Form for Television Channel Signals

Schedule II

(Refer sub-regulation (4) of regulation 10)

Application Form for Request of Signals of Television Channels

1. Name of the distributor of television channels:

2. The names of Owners/Directors/Partners of the distributor:

3. Registered Office address:

4. Address for communication:

1 Sub. by the Sixth Amendment Regulations, 2024, reg. 7 (w.e.f. 08.07.2024) for existing Schedule I

5. Name of the contact person/ Authorized Representative:

6. Telephone:

7. Email address:

8. Copy of certificate of registration/ permission/ license (Attach a Copy):

9. Details of Head-end, Conditional Access Systems (CAS) and Subscriber Management Systems (SMS) deployed by the distributor:

10. Details of the areas, corresponding States/ UTs and details of the Head-end from which the signals of television channels shall be distributed in such areas:

11. Area wise present subscriber base of the distributor:

12. List of channels and bouquets for which signals of television channels are requested:

13. Service Tax registration number:

14. Entertainment Tax Number:

15. PAN No. (Attach a copy):

16. Are the CAS/ SMS in compliance with the regulations:

17. Copy of the report of the Auditor in compliance of the ¹[Schedule III or the Schedule X or both, as the case may be,] of the Telecommunication (Broadcasting and Cable) Services Interconnection (Addressable System) Regulations 2017, if available:

(Signature) Date and Place

DECLARATION

I s/o, d/o (Owner/Proprietor/Partner/Director/Authorized Signatory), of (Name of Distributor of television channels), do hereby declare that the details provided above are true and correct. I state that the addressable systems installed for distribution of television channels meet the technical and other requirements specified in the ²[Schedule III or the Schedule X or both, as the case may be,] of the Telecommunication (Broadcasting and Cable) Services Interconnection (Addressable System) Regulations 2017. The configuration and the version of the addressable system have not been changed after issuance of the report by the Auditor. I agree to the above declaration

¹ Subs. by the Fifth Amendment Regulations, 2023 reg. 4 (a) (w.e.f 14.09.2023) for the following: "Schedule III"

² Subs. by the Fifth Amendment Regulations, 2023 reg. 4(b) (w.e.f 14.09.2023) for the following: "Schedule III"

(Signature) Date and Place

+91-9999709673

Email

Address