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Form A

Wireless license number. Email a copy of the license to the IMSI-A at IMSIadmin@iconectiv.com
Certifies the accuracy of the information provided in this application Commits to deploy any assigned HNI(s) within the time period specified by the assignment guidelines (Section 5.10) Certifies that the service to be provided with the HNI is for a public network that need to roam onto/from commercial public networks or for a service profile management system based in the U.S. for end user devices in the U.S. that can access such public network in the U.S. Certifies that any required authorization has been secured from the appropriate federal, state, or local regulatory bodies, or that such authorization is not required Acknowledges that it must remit an annual maintenance fee per the IMSI Assignment Guidelines and IMSI Oversight Council Operating Procedures Understands and agrees that the use of any assigned HNI(s) in a manner other than in conformance with the assignment guidelines may result in reclamation of the HNI(s) A non-refundable ($325 US) application fee is required for each application processed.
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