Form Ucc4002-Sm-Adm-01 - Application Form For Radiocommunication Services
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1
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3APPLICATION FORM FOR RADIOCOMMUNICATION SERVICES
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UCC4002-SM-ADM-01
SECTION A: ADMINISTRATIVE INFORMATION
Company
Trade name:
Contact:
Postal Address:
Physical Address:
City:
District:
Telephone Numbers:
Fax Number:
Email:
Company / NGO Registration Number:
Do you already have a license with UCC?
Yes.
No.
If the answer to the above is yes, what is your Customer Number?
Has any of your licences ever been cancelled, suspended, or modified?
Yes.
No.
If the answer to the above is yes, please explain why.
SECTION B:
CONTACTS
TECHNICAL
LEGAL
Name
ID / TIN number
Location
Township
City
District
Telephone Number
Postal Address
Email
Fax No.
Mobile
SECTION C:
DECLARATION
I, the undersigned, hereby declare that the information provided in the forms attached is true.
Name:
Official Title:
Date & Signature:
SECTION D:
FOR OFFICIAL USE ONLY
Application Received on (Date):
Customer Number:
This application has been processed and the following
Approved
action taken:
Additional Information Requested
Rejected
Frequency License Number:
Authorizing Officer/Title:
Date & Signature:
Note: Applicants are required to complete all fields for the specified equipment type for Fixed and Mobile
Stations
Uganda Communications Commission, UCC House, Plot 42/44 Spring Road, Bugolobi, P. O. Box 7376, Kampala. Tel:
41/31-339000 Fax: 41-348832/345278 Email: ucc@ucc.co.ug
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Parent category: Business