Electronic Communications Act, 2005 (Act No. 36 of 2005)RegulationsNumbering Plan Amendment Regulations, 2020SchedulesSchedule 3: Application form for numbering application |
SCHEDULE 3: APPLICATION FORM FOR NUMBERING APPLICATION
APPLICATION FORM FOR NUMBERING APPLICATION
Office use only |
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Application ref No. |
Application for Allocation, Assignment & Reservation of Codes or Blocks of Numbers |
Date |
1. Application Type:
e.g. 080, geographic, 086, Mobile. Do not mix types on this application |
Application for: |
Allocation |
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Assignment |
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Reservation |
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2. Applicant's Information |
Company Name |
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Company Reg. No. |
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License No. |
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Tel |
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Web Site |
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Internal Numbering Representative |
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Name and Surname |
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Contact No. |
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Fax |
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External Numbering Representative (In case of an applicant's using an external adviser e.g. consultant) |
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Company Name |
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Name and Surname |
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Contact No. |
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Fax |
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Business Address |
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Street Address |
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Suburb |
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Postal Code |
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City |
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Postal Address |
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P.O. Box |
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Suburb |
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Postal Code |
3. Technical Information |
Numbering code, block, individual number requested
(Where appropriate second and third preferences should be indicated. N.B. allocation of preferred requested numbering is not guaranteed) |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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Description of service
(For Individual number requests i.e 080 and 086 include the name of the person or entity requesting the number) |
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4. Previous Allocations (Relevant to this application) |
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Data date: (if date differs from the date of application |
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Service Description of Numbers |
Quantity (Allocated) |
Quantity (Active) |
A |
Allocated by The Authority |
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B |
Internal Network Services |
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C |
Contract Services |
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D |
Pre-Paid Services |
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E |
Total used for services/network (B+C+D) |
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F |
Degree of usage ((E/A)*100) |
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Numbers in Time Window Lock (i.e. numbers in recycling) |
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Numbers Reserved |
4.1 Report on utilization for the past 6 months |
Month 1 |
Month 2 |
Month 3 |
Month 4 |
Month 5 |
Month 6 |
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Actual numbers activated |
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Actual numbers churned |
I declare that all the information in this Application Form and any the attachments provided are true and correct. I understand that the approval from ICASA for this Application is based on the information as declared in this Application Form. Should any of the information declared, found to be inaccurate or incorrect after approval has been granted to the Applicant, ICASA reserves the right to suspend or revoke such approval without compensation. I declare that the numbers will be used in accordance with the numbering conventions.
Name:
Date:
Signature:
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Note:
Reservations will lapse after six months unless covered by an application for an allocation or a further period of reservation.