SCHEDULE-A

NON-TRANSFERABLE
Reference No. STV_______/2018-19
(for official use only)

APPLICATION FORM FOR A SATELLITE TELEVISION BROADCAST

STATION LICENCE
Please read the following instructions carefully before filling in the Application Form:
• To be submitted in duplicate after printing on A4 paper size;
• Give complete answers, use extra sheets if required, attach copies of other relevant documents, if required, to
illustrate an answer;
• Use the typescript or write in black ink in CAPITAL letters;
• Please attach documentary evidence of your authorization to act on behalf of the applicant company;
• One form can be used for only one category;

To,
The Pakistan Electronic Media Regulatory Authority,
Islamabad.

1. 1.1 Name of applicant company: __________________________________________

1.2 Full Name & title of CEO: _____________________________________________

1.3 CNIC No. of CEO: ___________________________________________________

1.4 Applicant company’s Registration No.: ___________________________________

1.5 National Tax No.: ___________________________________________________

1.6 Date of incorporation: ________________________________________________

1.7 Business Address: ___________________________________________________

1.8 Mailing Address [If different from above]: _______________________________

1.9 Telephone No.: ___________________ Mobile No.:________________________

1.10 Fax No.: _______________________ E-mail address:_____________________

1.11 Website: __________________________________________________________

2. 2.1 Proposed Location of broadcast station: __________________________________

2.2 Addresses of existing or proposed overseas offices:

_____________________________________________________________________

_____________________________________________________________________

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3. Category of licence (mark only one)

□ News & Current affairs □ Entertainment □ Education □ Sports □ Agriculture

□ Health □ Regional Language
4. Duration of Licence: Fifteen Years

5. Projected date of first transmission: _____________________________________

6. Non-refundable application processing fee: Rs. 200,000/-(Two hundred thousand)

Bank Draft/Pay Order No.: __________________Dated_________________(attached

in original) drawn on:______________________________________

7. Vision and policy of the channel (min 2000 words): [must be attached with the application]

7.1 Proposed language of the programmes:

□Urdu □English □Regional /Any other (please specify): _______________

7.2 Transmission- Hours, Minutes per day: ______________________________

8. Organizational set-up: (Organogram of the company to be submitted on separate sheet)

8.1 Names and addresses of the ultimate beneficial ownership of the

Company/Organization:

Sr. No. Name, address, CNIC Number

9. Technical Information:

9.1 Proposed location of broadcast station:________________________________

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 9.2 Information of the Proposed Satellite:

Name of
Satellite Please check the appropriate boxes
&Transponder
Encrypted Analogue C-Band Free-To-
Unencrypted Digital KU-Band Air
Compressed KA-Band Subscripti
on

9.3 Proposed Up-linking Facility: (Details of equipment, make, location, frequency, Satellite
Footprint with EIRP)
______________________________________________________________
______________________________________________________________

10. Funding Details: ________________________________________________

_______________________________________________________________
_______________________________________________________________

11. Socio-economic Impact: (Attach note of approx. 2000 words on the social benefits or objectives sought
to be achieved by the project)

12. Financial & Technical Feasibilities: (attach details as per schedule-H & I)

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 UNDERTAKING
I/We_________________________________, the applicant company do hereby declare that
the above facts are correct in all respects and nothing has been concealed or misrepresented
therein. I/We also undertake that:
(1) I/we shall respect the sovereignty, security, integrity and ideology of the Islamic Republic
of Pakistan;
(2) I/we shall respect the national, cultural, social and Islamic values and the principles of
public policy as enshrined in the Constitution of the Islamic Republic of Pakistan and to
safeguard the ideology of Pakistan;
(3) I/we have read and understood the eligibility criteria and bidding procedure and shall
strictly comply with the same in letter and spirit;
(4) I/we, if granted a licence, shall comply with PEMRA Ordinance, rules and regulations
made thereunder, the Code of Conduct, licence terms & conditions and instructions as
notified by the Authority from time to time and pay licence fee, annual fee including such
percentage of annual gross advertisement revenue as may be applicable, security deposit
and all such other dues as notified by the Authority;
(5) I/we, if granted a licence, shall broadcast programmes in the public interest specified by
the Federal Government or the Authority in the manner indicated by the Government or, as
the case may be, the Authority;
(6) I/we shall abstain from broadcasting any programme or advertisement in violation of
copyrights or other intellectual property rights;
(7) I/we shall obtain NOC from PEMRA before import of any transmitting apparatus for
broadcasting as required under Section 20 of the PEMRA Ordinance 2002;
(8) I/we shall not sell, transfer or assign any of the rights conferred by the licence without prior
written permission of the Authority;
(9) I/we have provided all documents which are required to be submitted along with the
application for STV channel licence and shall provide any further information if and when
required by the Authority;

Signature on behalf of Applicant company

Place _________________
Date __________________

Reference No.STV /2018-19

RECEIPT

Received Rs. 200,000/- through Pay Order/Bank Draft No.__________________________,

from___________________dated__________________through_____________________
today, the____________________________, 2014.

For
Pakistan Electronic Media Regulatory
Authority, Islamabad

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 SCHEDULE-C

NON-DEFAULTER STATUS AFFIDAVIT

(TO BE ATTESTED BY OATH COMMISSIONER)

I, _______________________________________S/o____________________________

(Designation)____________________________ of

M/s____________________________(hereinafter referred as “the applicant company”) do

hereby solemnly state and affirm on oath that neither the applicant company nor any of its

CEO, Directors and shareholders are defaulter of PEMRA, any financial institution, tax

authorities or the Government of Pakistan or any provincial and Local Government.

DEPONENT

VERIFICATION:

I, the above named deponent do hereby solemnly affirm on oath that the contents of the above

affidavit are correct and true to the best of my knowledge and nothing has been concealed

therein.

DEPONENT

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 SCHEDULE-D

AFFIDAVIT FOR COMPLIANCE

(TO BE ATTESTED BY OATH COMMISSIONER)

I, _______________________________________S/o____________________________

(Designation) ____________________________ of

M/s____________________________(hereinafter referred as “the applicant company”) do

hereby solemnly state and affirm on oath that the applicant company and its CEO, Directors

and shareholders shall abide by the PEMRA Ordinance 2002, the Rules, Regulations, licence

terms & conditions, guidelines, eligibility criteria, bidding procedure, Code of Conduct made

thereunder and as amended from time to time as well as the directions issued by the Authority

from time to time. I also undertake to pay the applicable licence fee, annual fee including the

percentage of the gross advertisement revenue as provided in the Schedule-B of the eligibility

criteria and bidding procedure, security deposit or as amended by the Authority from time to

time.

DEPONENT

VERIFICATION:

I, the above named deponent do hereby solemnly affirm on oath that the contents of the above
affidavit are correct and true to the best of my knowledge and nothing has been concealed
therein.

DEPONENT

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 SCHEDULE-E

AFFIDAVIT - CROSS MEDIA OWNERSHIP

(TO BE ATTESTED BY OATH COMMISSIONER)

I, _______________________________________S/o____________________________

(Designation) ____________________________ of M/s____________________________

(hereinafter referred as “the company”) do hereby solemnly state and affirm on oath that neither

the applicant company nor any of its CEO, Directors or shareholders directly or indirectly own,

operate or manage any distribution service network which may disqualify for getting a

broadcast media licence in terms of Rule 13 of the PEMRA Rules 2009.

DEPONENT

VERIFICATION:

I, the above named deponent do hereby solemnly affirm on oath that the contents of the above

affidavit are correct and true to the best of my knowledge and nothing has been concealed

therein.

DEPONENT

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 SCHEDULE-F

AFFIDAVIT - FOREIGN MEDIA OWNERSHIP

(TO BE ATTESTED BY OATH COMMISSIONER)

I, _______________________________________S/o____________________________

(Designation) ____________________________ of M/s____________________________

(hereinafter referred as “the applicant company”) do hereby solemnly state and affirm on oath

that the applicant company is not ineligible for grant of licence in terms of Section 25 of the

PEMRA Ordinance 2002 as amended from time to time or as provided in the eligibility criteria

and bidding procedure.

DEPONENT

VERIFICATION:

I, the above named deponent do hereby solemnly affirm on oath that the contents of the above

affidavit are correct and true to the best of my knowledge and nothing has been concealed

therein.

DEPONENT

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 SCHEDULE-G

AFFIDAVIT FOR NO BLACKLISTING STATUS

(TO BE ATTESTED BY OATH COMMISSIONER)

I, _______________________________________S/o____________________________

(Designation) ____________________________ of M/s____________________________

(hereinafter referred as “the applicant company”) do hereby solemnly state and affirm on oath

that neither the applicant company, nor any of its Directors and shareholders has ever been

blacklisted by PEMRA or any organization of Government.

DEPONENT

VERIFICATION:

I, the above named deponent do hereby solemnly affirm on oath that the contents of the above

affidavit are correct and true to the best of my knowledge and nothing has been concealed

therein.

DEPONENT

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 SCHEDULE-H

CHECKLIST FOR TECHNICAL FEASIBILITY OF THE APPLICANT COMPANY

Not
S. No Details Provided
provided
1 Name of satellite to be used along with its footprint
Technical parameters e.g. symbol rate, polarization,
2
FEC, Uplink & Downlink frequency
3 Detail of satellite bandwidth (in MHz) to be leased
Equipment / technology to be used e.g. DVB-S/DVB-
4
S2, compression technique e.g.MPEG-2/MPEG-4
Whether the channel will be Free to Air (FTA). If
5
encrypted, details of encryption
6 Details of studio equipment
Details of transmission, modulation type and
7
equipment
Details of uplink equipment, Block Up Converter
8
(BUC) and High Power Amplifier (HPA)
9 Number of DSNGs in case of a news channel
10 Editing facilities, delaying techniques and equipment
Proposed location of broadcast station and uplink
11
facility
12 Details of In-house monitoring mechanism
13 Details of remote access equipment (if any) & purpose

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 SCHEDULE-I

CHECKLIST FOR FINANCIAL FEASIBILITY OF THE APPLICANT COMPANY

Not
S. No Details Provided
provided
1 Financial feasibility study of the project:
i. Project cost with break-up.
ii. Capital Equipment along with cost
iii. Sources and uses of Funds statement
iv. Break Even analysis
v. Payback period
vi. Debt to Equity Ratio
vii. Pro Forma Income Statement clearly showing
sources of revenues i.e. subscription,
advertisements and projected operating& non-
operating expenses.
viii. Pro Forma Balance Sheet
ix. Pro Forma Cash Flow Statement

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