FORM E

REQUEST FOR INTERVENTION BY THE AUTHORITY FOR PURPOSES OF COORDINATING RADIO FREQUENCY SPECTRUM USE OR RESOLVING DISPUTES

1. PARTICULARS OF LICENCEES

1.1 Number of Licensees

1.2 Licence number of each Licensee

1.3 Nature of services authorised to be provided in terms of the Licence:

1.4 Expiry date of Licence of each Licensee:

1.5 Date on which coordination agreement, if any, was concluded:

1.6 Date/s on which ADR was attempted:

1.7 Attach a description of measures taken to reach agreement and/or a copy of the coordination

agreement, if any, marked clearly as Annexure A of FORM D1.

2. PARTICULARS OF LICENSEE/ APPLICANT 1

2.1 Full name of Licensee:

2.2 Designated contact person:

2.3 Licensee's street address:

2.4 Licensee's principal place of business

(if different from street address):

2.5 Licensee's postal address:

2.6. Licensee's telephone number/s:

2.7. Licensee's telefax number/s:

2.8. E-mail address of designated contact person:

3. PARTICULARS OF LICENSEE OR APPLICANT 2

3.1 Full name of licensee:

3.2 Designated contact person:

3.3 Licensee's street address:

3.4 Licensee's principal place of business (if different from street address):

3.5 Licensee's postal address:

3.6. Licensee's telephone number/s:

3.7. Licensee's telefax number/s:

3.8. E-mail address of designated contact person:

4. PARTICULARS OF LICENSEE/APPLICANT 3

4.1 Full name of licensee:

4.2 Designated contact person:

4.3 Licensee's street address:

4.4 Licensee's principal place of business (if different from street address):

4.5 Licensee's postal address:

4.6. Licensee's telephone number/s:

4.7. Licensee's telefax number/s:

4.8. E-mail address of designated contact person:

5. PROPOSED AMENDMENT TO THE LICENCE

5.1 Each applicant must set out the following as Annexure A of FORM D2:

(a)        Operator site (coordinates)

(b)        Frequencies in use

(c)        Technology in use

(d)        Power (EIRP)

(e)        Antenna gain

(f)        Height of antennas

5.2 Each applicant must set out the reasons for the dispute and attach the statements of fact supporting the claims, together with documented proof of previous attempts to resolve the dispute by negotiation between the parties marked clearly as Annexure A of FORM D3.

5.3 Each applicant must explain the implications (if any) if the dispute is not resolved and propose options for resolution of the coordination issue:

6. RADIO FREQUENCY SPECTRUM

6.1 Indicate whether the applicants all hold a radio frequency spectrum Licence. If so, attach a copies of the radio frequency spectrum Licences marked clearly as Annexure A of FORM D4:

6.2 In the event that an amendment to the applicant's radio frequency spectrum Licence is necessary, a separate application to amend the applicant's radio frequency spectrum Licence must be submitted to the Authority in this regard, simultaneously with this application.

7. UNDERTAKINGS

7.1 Provide details of undertakings (if any) and other matters which, in the applicant's view, the Authority may need to take into consideration:

7.2 Attach a resolution giving authority to the person signing this application, to do so. The resolution must be marked clearly as Annexure A of FORM D5.