Electronic Communications Act, 2005 (Act No. 36 of 2005)

Regulations

Purchase

FORM 11

JUDGEMENT FOR

I-BS and C-BS)

This Form must be submitted in accordance with Regulations Regarding Standard Terms and Conditions.

1.	Licence information

2.	Judgement against:

a.	Licensee? Yes/No

b.	Director? Yes/No

Name
ID Number

c. Senior management? Yes/No

Name

ID Number

3.	Conviction (Description):

4.	Date of Conviction:

5.	Case Number & Court:

Sentence:

7.	I, ......................................................................., in my capacity as ...............................................................hereby verify that the information provided is true and correct.

Signature

Designation

Date