VANS licence application form

Annexure A

APPLICATION FOR A LICENCE TO PROVIDE
VALUE ADDED NETWORK SERVICE (VANS).

1 PARTICULARS OF THE APPLICANT

1.1 Natural Persons

Name of the applicant:

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Nature of the business:

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Identification number of the applicant:

Permanent residential address:

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Principle place of business:

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Telephone number:

(....)...............

Fax number:

(....)...............

Cellular Number:

(....)...............

E-mail address:

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Companies and Closed Corporations:

1.2.1 Address

1.2.1.1

Business name:

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1.2.1.2

Nature of business:

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1.2.1.2

Registration number:

1.2.1.3

Principle place of business:

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1.2.1.4

Postal Address:

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1.2.1.5

Telephone number:

(....)...............

1.2.1.6

Fax number:

(....)...............

1.2.1.7

E-mail address:

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1.2.1.8

Please attach certified copies of all the founding documents of the applicant to this application. (Founding statement for CC, Shareholders agreement, Application for conversion from company to CC, Certificate of incorporation, Memorandum of association, Certificate of Incorporation for Section 21 Company, Deed of Trust, Certificate of change of name of company)

Shareholders

Note: If shareholders/members are more than the provided space, please submit their information on a separate sheet.

1). Name: ............................... Address: ............................ ............................ ............................ ............................ Tel No: (.....)..................... Fax No: (.....)..................... E-mail Address: .....................	Shares:	.........%
	Nature of Shares	[ ] Ordinary [ ] Preference [ ] Redeemable

2). Name: ............................... Address: ............................ ............................ ............................ ............................ Tel No: (.....)..................... Fax No: (.....)..................... E-mail Address: .....................	Shares:	.........%
	Nature of Shares	[ ] Ordinary [ ] Preference [ ] Redeemable

3). Name: ............................... Address: ............................ ............................ ............................ ............................ Tel No: (.....)..................... Fax No: (.....)..................... E-mail Address: .....................	Shares:	.........%
	Nature of Shares	[ ] Ordinary [ ] Preference [ ] Redeemable

4). Name: ............................... Address: ............................ ............................ ............................ ............................ Tel No: (.....)..................... Fax No: (.....)..................... E-mail Address: .....................	Shares:	.........%
	Nature of Shares	[ ] Ordinary [ ] Preference [ ] Redeemable

5). Name: ............................... Address: ............................ ............................ ............................ ............................ Tel No: (.....)..................... Fax No: (.....)..................... E-mail Address: .....................	Shares:	.........%
	Nature of Shares	[ ] Ordinary [ ] Preference [ ] Redeemable

6). Name: ............................... Address: ............................ ............................ ............................ ............................ Tel No: (.....)..................... Fax No: (.....)..................... E-mail Address: .....................	Shares:	.........%
	Nature of Shares	[ ] Ordinary [ ] Preference [ ] Redeemable

Description of the Service
Please tick the appropriate block(s)

A description of the proposed service(s) to be provided:

[ ]	Electronic Data Interchange (EDI)
[ ]	Protocol Conversion
[ ]	Access to Database
[ ]	E-mail
[ ]	Internet
[ ]	Managed Data Network Services (MDNS)
Other: ....................................................... ....................................................... .......................................................

2.1.2 Business plan, including projection of the market size and target market for the
proposed VANS for the first year of operation to be attached to this application.

2.1.3 License Fee income for the last financial year: R......................
Forecast of revenue for the first year in the case of new applicants.

3. Technical Description of the Network

3.1 Please attach to this application a description of all technical aspects of the
    network including but not limited to, network diagram, points of presence and the
    identification of telecommunications facilities provided by PSTS operator(s) and
    other relevant information.

3.2 Interfaces between PSTN and VANS network;

[ ]	V-Type interfaces: ....................................
[ ]	X-Type interfaces: ....................................
[ ]	Main path interfaces: .................................
[ ]	Network/Protocol interfaces: ..........................
[ ]	Other: ................................................ ....................................................... ....................................................... .......................................................

3.3 Equipment to be used by the applicant in the provision of VANS, not supplied
by a Public Switched Telecommunication Network (PSTN) operator:

[ ]	Routers
[ ]	Switches
[ ]	Hubs
[ ]	Bridges
Other: ............................................... ..................................................... .....................................................

3.4 Indicate telecommunications facilties to be used by the applicant, supplied
by a Public Switched Telecommunication Network (PSTN) operator:

[ ]	Diginet or Diginet Plus
[ ]	ISDN
[ ]	Saponet-P
[ ]	VSAT
Other: ............................................... ..................................................... ..................................................... .....................................................

3.5 Geographical area(s) where the proposed value added network service(s) will be
provided.

3.6 Please attach to this application, a certified copy of the type-approval
certificate issued by the Authority in respect of any telecommunications
equipment to be connected to a PSTN Operator.

4. To be completed by applicants who are natural persons:

   The employment strategies related to historically disadvantaged individuals:
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4.1 To be completed by applicants who are juristic persons.

   4.1.1 The employment strategies related to historically disadvantaged individuals:
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   4.1.2 Percentage of shareholding by historically disadvantaged individuals:
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5. Any other information the applicant deems relevant.
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