Electronic Communications Act, 2005 (Act No. 36 of 2005)RegulationsCompliance Procedure Manual Regulations, 2011FormsForm 4 : E - Rate Form |
FORM 4
E-RATE FORM
(I-ECS, I-ECNS, C-ECS and C-ECNS)
This Form must be submitted in accordance with E-Rate regulation published in terms of section 73 of the Act.
This Form should be submitted bi-annually in accordance with the Authority's Financial Year.
1. Licence information
Name of Licensee |
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Licence/s held |
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Registration or ID Number |
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Date submitted |
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Period under review |
2. The following table must be completed by all licensees providing services at E-rate:
Name of Educational Institution |
Date of Contract signature |
Services provided |
City / Province |
Effective date |
Reasons for Service cancellation |
If service cancelled, date resumed |
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| 3. | I, ......................................................................., in my capacity as ...............................................................hereby verify that the information provided is true and correct. |
4. Signature
Signature
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Designation
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Date
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