39. The holder of an authorization who applies for its suspension or revocation pursuant to section 122.2 of the Act must file, with the authority that issued the authorization, the following information:(1) the number and date of issue of the authorization for which suspension or revocation is requested;
(2) the reason for which suspension or revocation of the authorization is requested;
(3) in the case of an application for suspension, the period for which suspension is requested;
(4) in the case of an application for revocation, the date on which revocation is requested;
(5) a declaration by the applicant that all the information and documents provided are accurate and complete.