Annexure A

APPLICATION FOR A LICENCE TO PROVIDE
A PRIVATE TELECOMMUNICATION NETWORK (PTN).

1 PARTICULARS OF THE APPLICANT

Juristic persons:

1.2.1 Address

1.2.1.1 Business name: .............................................
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: .............................................
1.2.1.9 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, Certficate of incorporation, Memorandum of association, Certificate of Incorporation for Section 21 Company, Deed of Trust, Certificate of change of name of company)

Purpose of the PTN

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Technical Description of the Network

The are of operation of the proposed PTN, (contain a description of all technical aspects
of the network including but not limited to, network diagram, demarcated private property(s),
points of interconnection with PSTN(s) and the identification of telecommunications facilities
provided by PSTN if applicable and any other relevant information:

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3.2 Interfaces between PSTN and PTN;

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

Other:

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

[ ] Routers
[ ] Switches
[ ] Hubs
[ ] Bridges

Other:
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3.4 Indicate telecommunications facilties to be used by the applicant,
    supplied by a PSTN Operator:

[ ] Diginet or Diginet Plus
[ ] ISDN
[ ] Saponet-P
[ ] VSAT

Other:

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

4.  Any other information the applicant deems relevant.

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