PAKISTAN ELECTRONIC MEDIA REGULATORY AUTHORITY

TEL # 051-9107114, 9107159 FAX # 051-9107140

CABLE TELEVISION OPERATION APPLICATION FORM

Date of Application
- -
 Application form should be (TYPEWRITTEN & BLOCK LETTER). (dd-mm-yyyy)
 Separate sheet of paper may be used if necessary.
 *Section 22 of PEMRA Ordinance 2002 only applies on submission of complete application / documents by the
applicant.

Attach 2
Part I- Corporate information passport size
photographs
1. Firm/Company’s Particulars:

1.1 Name of Firm/Company:

1.2 Registered Address:

1.3 Business Address:

1.4 NTN

1.5 Registration No. Of Firm / Company

1.6 Date Of Incorporation Establishment of Firm / Company

1.8 Fax No.

Page 1 of 5
 1.9 Email

1.10 Website

1.11 City

(Description)

1.12 Region / Province

(Description)

Part II- Corporate Setup

2.1 Corporate Setup

Sole Proprietorship
Private Limited
Partnership
Public Limited

2.2 Share’s Detail of Proprietor/ Partner(s)/ Director(s)

Sr. No Name of Proprietor / Partner / Director Designation Percentage Share Holding

2.3 Name Of CEO

2.4 NIC No.

Page 2 of 5
2.5 Phone No. (Residence )

2.6 Name Of Authorized Person

2.7 NIC No.

2.8 Phone No. (Residence )

Part III- Technical information

Presently

Excepted

3.3 Number of Head Ends

3.4 Locations of Head Ends

2)

3)

3.5 Proposed Date Of Commencement of Business

Page 3 of 5
3.6 City / town / village in which the cable TV network is working / proposed to be setup.

3.7 Area of Operation (Only geographically contagious area be mentioned, which will be covered by CTV operation)

3.8 Name / Numbers of Channels being provided / proposed to be provided

3.9 Fee with Application

3.10 Demand Draft / Pay order / Challan No.

3.11 Demand Draft / Pay order / Challan Date

3.12 Name Of Bank / Branch / Code

3.13 Proposed CTV business / project cost

I hereby agree to abide by the conditions of cable TV license; Regulations, PEMRA Ordinance, 2002 and
other directives issued by PEMRA from time to time.

Signature of authorized person / CEO

Date: __________________
Page 4 of 5
Note: The application will not be entertained unless the applicant is a registered firm or company

Part IV- Check List (Official Use Only)

a) Organizational information (organization chart, no of personnel, job descriptions along with

b) Technical information (system design, detail of head end components including number of
dishes, description of network transmission system etc. provide technical brochures of the
system components)

c) Financial Information (a) Projected Profit & Loss Account and Balance Sheet for five
years, (b) Projected Cash Flow Statement, (c) Estimated Project Cost Statement, (d) Bank
Statement in Firm’s Name showing balance equal to or more than estimated project cost)

d) Original Demand Draft Pay Order or Challan Farm for Rs.5000/- on account of application
evaluation fee payable in PEMRA A/C No.000801-1650-654-6, Askari Commercial Bank,
Limited, Jinnah Avenue Branch, Islamabad.

e) Attested photocopies of NIC of CEO, authorized person and all partners along with,
passport-size photographs.

f) Attested photocopy of NTN certificate in firm’s name.

g) Attested photocopy of Partnership Deed with Cable TV business clause in it

h) Attested photocopy of Certificate of Registration / Incorporation of firm showing Cable TV

i) References from two persons along with attested photocopies of their NICs.

j) Population Certificate from Tehsil Nazim.(For Rural Category)

k) Interconnect Agreement. (For Loop-Holder Category)

l) Character Certificate from Local Police Station.

Complete In Complete

Kindly Code the Region and City

City Region
Remarks _______________________________________________________________________________
_______________________________________________________________________________

Signature of Authorized Officer______________________

Page 5 of 5