Universal International Shared Cost Number Request Form (UISCN)
(ITU-T Recommendation E.169.3)* (one form per number request)
To be returned with registration fee 1) to :
UISCN 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
Transmittal date: (a) _______________
Company name
Contact name
Address
Telephone number
Fax number
Email
(b) _____________________________________________
(c) _____________________________________________
_____________________________________________
_____________________________________________
(d) +____________________
+____________________
____________________
Request type (mark with an X) (e)
Reason for change
New
Change
Disconnect
Cancel
(f) ___________________________________________________________
Universal International Shared Cost Number requests, acceptable alternatives in order of priority:
1) +808 __ __ __ __ __ __ __ __
6) +808 __ __ __ __ __ __ __ __
2) +808 __ __ __ __ __ __ __ __
7) +808 __ __ __ __ __ __ __ __
3) +808 __ __ __ __ __ __ __ __
8) +808 __ __ __ __ __ __ __ __
4) +808 __ __ __ __ __ __ __ __
9) +808 __ __ __ __ __ __ __ __
5) +808 __ __ __ __ __ __ __ __
10) +808 __ __ __ __ __ __ __ __
Remarks:
(g) ___________________________________________________________
ISCS customer name
Customer's address
(h) _____________________________ _______________
_____________________________________________
_____________________________________________
Expected ISCS customer due date (i)
_____________
Is ISCS customer embedding entire existing national SCN
(j) Yes [ ]
No [ ]
Existing national SCN that is being embedded
(k) CC ______ SCN ________________
Existing national SCN implemented prior to 1 February 1999 (l) Yes [ ]
No [ ]
Country(ies) with which the ISCS will be implemented initially
(m)
_____________________________
Coordination (reference) number
(n) _________________
Payment of the registration application fee: (o) _________________ 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.154