BUSINESS CONFIDENTIAL INFORMATION
Attachment G 

Personally Identifiable Information Supplement to Standard Questions
Applicant/Petitioner/Licensee Name(s): 
FCC File Number(s): 

* To expedite review, please provide all personally identifiable information (PII) in the format below. 

Name
Company Role/Title and/or Ownership % 
All Countries of
Citizenship 
Date and Place of Birth
U.S. Alien Number
(if applicable).  
Identify whether the individual is a U.S. Lawful Permanent Resident.
Social Security Number
(if applicable)
Passport No. and
Country
Residence Address
Business Address
Phone Numbers
(Work, Cell)

Identify the  Applicable Form(s) and Question(s) for PII Entered on Each Row
Individuals or Entities with Ownership Interest in Applicant, Petitioner/Licensee, or Relevant Party






















Non-U.S. Individuals with Access






















Corporate Officers, Senior Officers, Directors






















Law Enforcement Point of Contact