Application Form For The Grant Of Licence For Internet Protocol Television (Iptv) Distribution Service

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APPLICATION FORM FOR THE GRANT OF LICENCE FOR INTERNET PROTOCOL
TELEVISION (IPTV) DISTRIBUTION SERVICE
FORM (NON-TRANSFERABLE)
No. IPTV/Company Name/2016/------ --------------------------------------- (To be filled in by PEMRA)
Date of Application: ---------------------------------------
Please read the following instructions before filling the Application Form:
 Give complete answers, use extra sheets if required, attach copies of any relevant documents
required to illustrate the answers.
 Use the typescript or write in black ink in capital letters.
 Attach documentary evidence of your authorization to act on behalf of the applicant
Company.
 Submit the Application Form along with all the required documents & information in
duplicate.
1.
PROFILE OF THE APPLICANT COMPANY
1.1
Company Name
__________
1.2
Name of the CEO
__________
1.3
CEO National Identity Card No.
______________________
1.4
Company registration No.
__________
1.5
National Tax No.
__________
1.6
Date of establishment/incorporation
__________
1.7
Business Address
__________
1.8
Mailing Address
__________
1.9
Telephone No. ________________________ Cellular No.
__________
1.10
Fax No. _____________________________ Email
__________
1.11
Website
__________
1.12
Does the object clause in the Article & Memorandum of Association of the company
allows entry of the company in electronic media / IPTV?
________________
1.13
Location of applicant’s Head Office
__________
1

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