Form G – Application for an IBN Assignment for a Shared HNI

• Certifies the accuracy of the information provided in this application.
• Commits to deploy any assigned IBN with the Shared CBRS HNI within the time period specified by the assignment guidelines.
• Certifies that the service to be provided adheres to the Assignment Principles (per Section 6 of this document).
• 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 code holder fee per the IMSI Assignment and Management Guidelines for Shared HNIs for CBRS Range.
• Understands and agrees that the use of any assigned IMSIs in a manner other than in conformance with the assignment guidelines may result in reclamation of the code(s).
• Understands and agrees that the use of any assigned IBN(s) in a manner other than in conformance with the assignment guidelines may result in reclamation of the IBN(s) A non-refundable application fee is required for each application processed.
• Certifies that it is authorized to provide services in the CBRS range utilizing Radio Technologies as noted above.