(ITU-T Recommendation E.169.3)
To be returned to :
Part A to be filled out by the recognized operating agency (ROA)
UISCN Registrar
International Telecommunication Union
Telecommunication Standardization Bureau
Place des Nations
CH - 1211 GENEVA 20, Switzerland
Tel: +41 22 730 6220 Fax : +41 22 730 6200
Email: universalnumbers@itu.int
Transmittal date: (a) _________________
Company name/ROA
Contact name
Address
Telephone number
Fax number
E-mail
UISCN number
ISCS customer name 1)
Customer’s address 2)
(b) __________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
+ ____________________
+ ____________________
____________________________________
(c ) +808 __ __ __ __ __ __ __ __
(d) ____________________________
(e) ____________________________
____________________________
------------
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)
[
[
Date of activation is:
] The above UISCN has been implemented
] The above UISCN was disconnected
____ ____ ____
Day Month Year
Co-ordination (reference) Number : _________________________________
Reasons : (g) ________________________________________________________
________________________________________________________