Form 4 Regulation 8(1) THE REPUBLIC OF UGANDA THE ELECTRONIC SIGNATURES REGULATIONS, 2012 APPLICATION FOR EXCEMPTION FROM LICENCE To the Minister 1. Particulars of applicant: (a) Name: …………………………………………………………… (b) Physical address: ……………………………………………………………………. ……………………………………………………………………. (c) Postal address: …………………………………………………… ……………………………………………………………………. (d) Telephone (fixed line): …………………………………………… (e) Mobile phone:…………………………………………………… (f) Fax: ……………………………………………………………… (g) E-mail address:………………………………………………….. 2. Legal status of applicant: Indicate legal status of applicant (Attach certificate of incorporation, memorandum and articles of association where applicable) 3. Particulars of directors: Name (a) Address Nationality Country of usual residence