Class License Registration and Payment

Made in pursuant to Part 3 of the Telecommunications, Radiocommunications and Broadcasting Regulation Act as amended.

Applicant Information

Full Name

Date of Birth

Gender Male Female Other

National ID / Passport No.

Phone Number

Email address

Home Address

Company Directors and Management

Full Name

Appointment

Date Appointed

Nationality

Email Address

Phone Number

Class / License Details

Name of Organization

Class Category Reseller of Network Reseller of services Reseller of content

Company Registration Number

Attach copy from VFSC

Company Business License Number

Attach a copy from Customs

Website address

Start Date

Networks and Services to be supplied

Provide a narrative description of the Network

Geographical coverage

Number and categories of customers expected to be served

Business and Marketing

Provide details of proposed rates or tariffs for services to be offered

Provide a standard fair usage policy for between provider and Customer

Registration Fee

Fee in Vatu (4% Bank charge included)

Declaration

I hereby declare that the information provided in this form is true and complete. I understand that providing false information may result in rejection or cancellation of my registration.

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