Universal International Premium Rate Number Multiple ROAs Notification Form
(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 recognized
operating agency (ROA)
Company name/ROA
Contact name
Address
(b)_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
+____________________
+____________________
____________________________________
Telephone number
Fax number
E-mail
UIPRN number
IPRS customer name 1)
Customer’s address 2)
Transmittal date: (a)_______________
(c)
(d)
(e)
+979 X __ __ __ __ __ __ __ __
____________________________
____________________________
-----------1) The Registrar will not record any change of information if the customer’s name is not the same as the one
recorded in the Registrar’s database.
2) The Headquarters or Main Office address
(check appropriate box)
(f)
[]
The above UIPRN has been implemented or is in the Reserved State.
[]
The above UIPRN was disconnected.
Date of activation is:
____
____
____
Day
Month
Year
Co-ordination (reference) Number : _________________________________
Reasons :
(g)
________________________________________________________
________________________________________________________