Bt Mobile Phone Contract by vlw18149


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									                                                                                                                              Radio Site Sharing

                                                                                 Application Form
                    Always download the latest version of this application form, prior to submission, from

                                                          SUBJECT TO CONTRACT
Please fully complete all relevant sections of this form in order to assist BT with ensuring that your application is properly
considered. If advice is required on completion of the form or radio site sharing matters in general, please contact BT on the
telephone numbers given at the end of the form.

1. Site      The site may be known by a different name locally. To aid identification please quote the national grid reference.
 Full name of site
 Licensed Customers name                                                     Are you a current sharer on this site?                     Yes / No
 Customer Site Name                                                          Customer Cell Ref:
 National grid reference e.g. AB1234 5678                                    County & nearest Town

2. Applicants Details                   Full Customer names are required for licensing purposes. Refers to Licensed Customer
 Licensee name:                                                             Correspondence address:

                                                                            E mail address:

 Address of registered office:                                              Invoicing Address:

                                                                            VAT No

3. Customer Contact                    This should be the name and telephone number of the person managing the application.
 Applicant’s Company
 Name & Address.
 Contact name
 Telephone No.
 Mobile Phone No.
 E mail address.

4. Work Category                  Please Suggest which category this work may fall into
 Tower Works                                                                    Ground Works
 Provide                                                                        Cabin Provide
 Recover                                                                        Cabin Recover
 Replace - Size down                                                            Cabinet Provide
 Replace – Like for Like                                                        Cabinet Recover
 Replace – Size Up
 Site Decommission

                     British Telecommunications plc Registered office 81 Newgate Street LONDON EC1A 7AJ Registered in England No. 1800000.
Issue 14 – v06/10
                                                                                                                                              Page 1 of 3
Application No: BP
5. Requested Service Date                Please provide a realistic and specific date by which you require to have the requested
facilities available for use. Actual Ready For Service (RFS) dates will depend upon size and complexity of the order.

                     British Telecommunications plc Registered office 81 Newgate Street LONDON EC1A 7AJ Registered in England No. 1800000.
Issue 14 – v06/10
                                                                                                                                              Page 2 of 3
Application No: BP
6. Equipment Details                   (Refer to separate documents if required)
          Manufacturer              Function             Type          Tx freq.               Rx freq.        Band         Power                IF
                                                                                                              Width        Output (dBW)         (MHz)
 e.g.               NEC             2Mbit/s fixed link        DRS1000       22.965GHz         24.825GHz        6MHz             -10                70

7. Antenna Details This is what you want to end up with.                                           (Refer to separate documents if required)
          Manufacturer          Type      Size    Frequency      Height Min/        Bearing        Poln H/V     Feeder Type     No. of        Total ERP
                                          (m)     Band           Max. (m)           Deg EoN                                     Feeders       dBW
  e.g.      ANDREW              DISH      1.2       23GHz             20-25             230              V       EPW150             2            35

 Please state which antennas require external RF units
 and where they should be located.
 e.g. RFU at ground level

8. RF Radiation Safety            Please attach a clear specification, including diagrams where relevant, of the minimum safe
distances around each antenna for personnel to be present whilst the antenna is operational. Also provide a copy of your operational
procedure for de-powering of equipment to provide safe working on your antenna if requested by BT.
 Information                    If No please give reason why this information is not provided:

9. Additional Information This is what you want BT to do and cost. Please include any additional
information that you consider is required to fully describe your site sharing requirements, including preferences for supply of external
stores such as steelwork, antennas, feeders, clamps, termination & earthing kits. (Refer to separate documents if required)

                     British Telecommunications plc Registered office 81 Newgate Street LONDON EC1A 7AJ Registered in England No. 1800000.
Issue 14 – v06/10
                                                                                                                                                  Page 3 of 3
Application No: BP
10. Power Requirement               A Landlord’s Power Supply may be available, please complete below with your needs if you
require this supply. A separate charge for electricity will be added to the annual fee for sharing of the radio site.
 Normal power consumption of all   Maximum power consumption of all Number of 13A sockets
 equipment                         equipment                             required
                   00000 (kWatts)                         00000(k Watts)
 BT Supply Generator Back up Required – additional costs will apply      Yes / No

11. Equipment Accommodation Requirements                              Limited Accommodation may be available in a site sharing area
at BT’s Discretion. Please provide details in the table below so we can assess if accommodation will be available.
 Rack No.      Height (mm)          Width (mm)             Depth (mm)            Front & Rear Access       Power Dissipation (kw)
If the application needs new external accommodation in the site share compound, cabins or cabinets must be used, subject to Local
Authority planning restrictions. Please provide details in the table below
  Cabin / Cabinet            Height (mm)                Width (mm)             Depth (mm)                 Qty

12. Conditions of Application
In consideration of BT processing this application the applicant undertakes with BT to reimburse all of BT’s reasonable costs incurred
in processing this application, including administration, legal costs, design, approval, materials, installation and supervision and any
costs incurred in obtaining consents of third parties. Such costs shall be reimbursed whether or not the application results in an offer
of facilities and whether or not the applicant withdraws this application at any time.

The applicant acknowledges that BT reserves the right to refuse any site sharing application and that BT is not bound to disclose its
reason that lead to that decision.

The applicant further acknowledges that although BT will use its reasonable endeavors to process and provide any agreed site sharing
facilities to the applicant’s satisfaction BT shall not be liable for any loss or damage incurred as a result of failure to meet any quoted
provision time-scales.

If the application is successful, BT will require evidence of the granting of an operating licence for the facilities by the DTI/Radio
Communications Agency. The applicant will also be responsible for obtaining all necessary local authority planning permissions or
consents and providing evidence of such consents to BT.

For some applications, BT will require Purchase Order Cover in advance of any works being undertaken. BT will tell you in advance if
this is the case.

13. Declaration
I confirm that the information provided in this application is correct and agree to the conditions of the application set out above
on behalf of:
This application must be signed to confirm acceptance of the terms and conditions.

Name: (please print name)                                                           Position:
Signature:                                                                          Date:

The completed application form should be submitted to email address:
If you have any queries concerning its completion please contact one of our site share managers as below

David Cunningham                 0141 220 7119       Bill Drury          01442 208075         Robin Fuller                  01892 669684
Colin Jennings                   0121 354 7741       David Maidlow       020 7250 5026        Alan Roberts                  020 7250 5032
Christopher Thomas               01792 638545
                     British Telecommunications plc Registered office 81 Newgate Street LONDON EC1A 7AJ Registered in England No. 1800000.
Issue 14 – v06/10
                                                                                                                                              Page 4 of 3
Application No: BP

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