Universal International Freephone Number Request Form (UIFN)
(ITU-T Recommendation E.169)* (one form per number request)
To be returned with registration fee 1) to :
UIFN Registrar
International Telecommunication Union
Telecommunication Standardization Bureau
Place des Nations
CH - 1211 GENEVA 20, Switzerland
Fax:
+41 22 730 6200
Tel:
+41 22 730 6220
E-mail: universalnumbers@itu.int
Part A to be filled out by the applicant
Transmittal date: _______________
Company name
_____________________________________________
Contact name
_____________________________________________
Address
_____________________________________________
_____________________________________________
Telephone number
+____________________
Fax number
+____________________
Email
_____________________
Request type (mark with an X)
New
Change
Disconnect
Cancel
Reason for change ___________________________________________________________
Universal International Freephone Number requests, acceptable alternatives in order of priority:
1) +800__ __ __ __ __ __ __ __
6) +800__ __ __ __ __ __ __ __
2) +800__ __ __ __ __ __ __ __
7) +800__ __ __ __ __ __ __ __
3) +800__ __ __ __ __ __ __ __
8) +800__ __ __ __ __ __ __ __
4) +800__ __ __ __ __ __ __ __
9) +800__ __ __ __ __ __ __ __
5) +800__ __ __ __ __ __ __ __
10) +800__ __ __ __ __ __ __ __
IFS customer name
Customer's address
_____________________________________________
_____________________________________________
_____________________________________________
Expected IFS customer due date _____________
Is IFS customer embedding entire existing national FSN
Yes [ ] No [ ]
Existing national FSN that is being embedded
CC ______ FSN ___________________
Existing national FSN implemented prior to 1 December 1994 Yes [ ]
No [ ]
Country(ies) with which the IFS will be implemented initially _____________________________
Coordination (reference) number
____________________
Payment of the registration application fee: _________________ Swiss francs
Specify the method of payment :
[ ] – by bank transfer to ITU account No. 240-C8-765.565.0, UBS, Geneva (Switzerland);
IBAN: CH96 0024 0240 C87655650 SWIFT No. UBSWCHZH80A Clearing No. 240
[ ] – deduction from the applicant's prepaid account
[ ] – Major Credit Card
_____________________________
1)
the fee is currently 200 Swiss francs
*)
for service description, see also ITU-T Recommendation E.152