Independent Communications Authority of South Africa Act, 2000 (Act No. 13 of 2000)

Regulations

Purchase

FORM 4

(I-ECS, I-ECNS, C-ECS and C-ECNS)

This Form must be submitted in accordance with E-Rate regulation published in terms of section 73 of the Act.

This Form should be submitted bi-annually in accordance with the Authority's Financial Year.

1. Licence information

2. The following table must be completed by all licensees providing services at E-rate:

Name of Educational Institution	Date of Contract signature	Services provided	City/Province	Effective date	Reasons for Service cancellation	If service cancelled, date resumed

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

Signature

Designation

Date