150
CAP. 411A
Kenya Information and Communications
[Subsidiary]
ITEM
NO
[Rev. 2011
First Schedule—(Contd)
MAKE,
MODEL,
TYPE OF
EQUIPMENT
D
A
T
E DATE OF
P R O V I S I O N A L LY INSTALLATION
APPROVED BY CCK
& REFERENCE
NUMBER
POSTAL,
TELEPHONE,
FAX, E-MAIL
& PHYSICAL
ADDRESS OF
REFERENCE
Please continue on a separate sheet. Also attach details of employees and their qualifications and
details of workshop.
4.
DECLARATION
I hereby apply for Final Type Approval/Acceptance/authority to market the equipment(s)
specified above in Kenya on behalf of my company I certify that all information I have
given in this form is correct to the best of my knowledge.
Applicant’s Name ………………………….. Sign …………… Date ………
Contact Tel No ………………………….
5.
FOR OFFICIAL USE ONLY
(i)
(ii)
(iii)
(iv)
Case No …………………………………….
Evaluating officers name …………………… Sign …………
Approval Recommended/Not Recommended (Delete where not applicable).
TAC No./Item No ……….. Approved/Not Approved/Deferred (Delete
where applicable).
CONTACT
PERSON &
RANK IN
ESTABLIS
HMENT