NCA FORM AP25R -- 1
NATIONAL COMMUNICATIONS AUTHORITY
(NCA), GHANA
APPLICATION FOR SUBMARINE
CABLE LANDING STATION
LICENCE
NCA FORM AP25
Application Fee
Receipt No:
(Please attach Receipt)
Date:
(Submission Date)
Application Checklist. Tick (x) in box
• A completed Application Form
• Cover Letter
• Letter of Commitment
• Copy of Valid National ID of the Contact
Person(s)/ Authorised Representatives
• Business Plan
• A Non-Refundable Application Fee
• TaxClearanceCerticate
• SSNITClearanceCerticate
• Supporting Documents
a. Company Registration Documents
b. Location of Landing Stations in
Ghana
c. Capacity of the Submarine Cable
d. Countries in which submarine
cable will be landing
e. Member(s) of Consortium
(Where applicable)
NCA FORM AP25R -- 2
Application for Submarine Cable Landing Station Licence
Before completing this form, please ensure that you have read and understood the guidelines. Comply with all the require-
ments listed for the application of this service. A copy of the guidelines may be found on our website: www.nca.org.gh
1. Corporate Prole
1.1 Registered Name of Company:
1.2 Registered Trade Name (if any):
1.3 Company Registration Number:
1.4 TaxpayerIdenticationNumber(TIN):
1.5 Date of Incorporation:
1.6 Date of Commencement:
1.7 PhysicalLocation/RegisteredOce:
1.8 District:
1.9 Town/City:
1.10 Region:
1.11 Postal Address:
1.12 Digital Address (GhanaPost GPS):
1.13 Telephone:
Mobile Phone:
1.14 Website:
1.15 E-mail address:
1.16 Fax (where applicable):
2. Contact Information: APPROVED CONTACT PERSONS/REPRESENTATIVES
A B
2.1 First Name First Name
2.2 Last Name Last Name
2.3 Position in Org. Position in Org.
2.4 Nationality Nationality
2.5 IdenticationType IdenticationType
2.6 IdenticationNo. IdenticationNo.
2.7 E-Mail E-Mail
NCA FORM AP25R -- 3
2.8 Business Telephone Business Telephone
2.9 Mobile Number Mobile Number
3. Ownership Structure:
3.1 Shareholders (holding 5% or more shares):
NO. NAME OF SHAREHOLDER
SHARE
HOLDING (%)
ADDRESS
(house number, telephone number &
email)
TAXPAYER
IDENTIFICATION
NUMBER (TIN)
4. Directors:
4.1 Directors (holding 5% or more shares):
NO. NAME OF DIRECTOR
ADDRESS
(house number, telephone number & email)
TAXPAYER
IDENTIFICATION
NUMBER (TIN)
5. Number of Employees:
5.1 Number of Employees (Actual):
5.2 Number of Employees (Proposed):
6. Undertaking:
I/We ……………………………………………………………………………..………… hereby certify that the
information supplied in this application form is true in all respects and I/We hereby give undertaking that upon
grant of the Licence/Authorisation, I/We shall abide by the terms and conditions upon which the Licence/
Authorisation is granted. I/We accept that my/our Licence/Authorisation may be revoked and the appropriate
penalty / penalties applied if it is established that I/We have been granted Licence/Authorisation based on
incorrect information. I/We further undertake to abide by all existing ITU Regulations and Communications
laws of the country as well as other rules and regulations that may be issued.
NCA FORM AP25R -- 4
Signed: Date:
Please attach 3 Certied copies of Passport Photographs of authorised representative with Company Seal.
Notes / Guidelines to Application Form
1. The Application Form must be completed and signed by the authorized representative of the
Applicant(s).
2. Application Form and supporting Documents to be submitted in triplicates in addition to soft
copies on CD – Rom or Pen Drive.
3. National IDs should be valid at the time of submission of the Application Form. Acceptable IDs to
be used are:
a. Driving Licence
b. Passport
c. Voter’s ID Card
d. NationalIdenticationCard
4. Payment of the requisite application fee is to be made by Bankers’ draft to the National
Communications Authority. Note that payment is non-refundable.
5. TheApplicationFormistobeaccompaniedwithCertiedTrueCopiesoftheBusinessIncorporation
Documents.
6. The Business Plan should include the:
a. Organizational Structure of entity (include educational and technical background as well
asexperienceofkeypersonnelsuchasCEO/ManagingDirector,ChiefTechnologyOcer,
ChiefInformationOcer,ChiefFinancialOcer,ChiefMarketingOcer,etcasmaybe
applicable).
b. Audited Financial Statements for the past Five (5) years of operation, to include:
i. Income Statement
ii. Balance Sheet
iii. Cash Flow Statement
7. Applicant is required to provide location of the Landing Station in Ghana
8. Applicant is required to provide the capacity of the Submarine Cable
9. Applicant is required to provide the countries in which the Submarine Cable will be landing.
10. Applicant is required to provide list of members if ownership of the Submarine Cable is through a
consortium.
NCA FORM AP25R -- 5
SERVICE DEFINITION
Submarine Cable Landing Licence - Means an electronic communications facility, including where
applicable, collocation space, monitoring equipment, space on or within ducts, cable trays,
conduits and beach joints that house the electronics and are used to connect an international
submarine cable to land based electronic communications facilities and includes all associated
support systems, subsystems and services, ancillary to such international submarine cables and
electronic communications facility.