Applicant’s Name.............................Sign.........................Date..........................
Contact Tel No..........................................
5.
FOR OFFICIAL USE ONLY
(i)
(ii)
(iii)
(iv)
Case No.............................................
Evaluating officers name...........................Sign.............................
Approval Recommended/Not Recommended (Delete where not applicable).
TAC No./Item No................ Approved/Not Approved/Deferred (Delete
where applicable).
Form No. 4
Regulation 56
COMMUNICATIONS COMMISSION OF KENYA
APPLICATION FOR INDIVIDUAL AUTHORITY TO USE
TELECOMMUNICATION TERMINAL EQUIPMENT
1.
PARTICULARS OF APPLICANT
(i)
Full names of Applicant/Company
....................................................................................................
P.O. Box.........................Tel No................................................
(ii)
Physical Address where the equipment will be used
Town....................Road/Street/Estate.................Building.....................
(iii)
Details of Network in which the equipment is to be connected (i.e.
Radio/Data etc)……………………………............................................
(iv)
Type of service for which the equipment is intended to be used (e.g.
ISP access, Bureau, Residential voicemail, etc)
....................................................................................................
(v)
Telephone/Circuit number(s) to which the equipment will be connected
(where applicable)
........................................................................................................................
2.
DESCRIPTION OF EQUIPMENT
ITEM
NO
TYPE
MANUFACTURER
MAKE AND
MODEL
81
SERIAL
NUMBER/IMEI
COUNTRY
OF ORIGIN