Universal International Premium Rate Number Status Notification Form

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Universal International Premium Rate Number Status Notification Form

1)

(ITU-T Recommendation E.169.2)

To be returned to : UIPRN 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

Email: universalnumbers@itu.int

Part A to be filled out by the applicant

Contact name

Transmittal date: (a)_______________

(b) _____________________________________________

Address (c ) _____________________________________________

_____________________________________________

Telephone number

Fax number

Email Address

(d) +____________________

+____________________

____________________

The following UIPRN has been implemented: (e)

+979 X __ __ __ __ __ __ __ __

Date of activation is: (f) ____

Day

____

Month

Coordination (reference) number: (g) ____________________

____

Year

IPRS customer name

Customer's address

(h) _____________________________________________

_____________________________________________

_____________________________________________

Remarks : ( i) _____________________________________________

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1

) This Form must be returned no later than 180 days after the reservation of a UIPRN number with the

Registrar, otherwise the number will be cancelled.

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