The Laws of Zambia

SECOND SCHEDULE

(Regulation 3 (4))

FEE PROCESSING FORM

1.

Applicant's name ............................................................................................................................................................

2.

Mailing address ..............................................................................................................................................................
........................................................................................................................................................................................
........................................................................................................................................................................................

3.

Town ..............................................................................................................................................................................

4.

State/Country
(If foreign Address) ........................................................................................................................................................

5.

Broadcasting Station ......................................................................................................................................................

6.

Call Sign ..........................................................................................................................................................................

7.

Type of Fee(s) ................................................................................................................................................................
........................................................................................................................................................................................
........................................................................................................................................................................................

8.

Total amount due: fee units.................

9.

Total amount remitted
with this Application: fee units ........................................................................................................................................

10.

Mode of Payment:

11.

Form of Payment:

By post ......................................................................................................................................
Hand Deliver ..............................................................................................................................
Cash ..........................................................................................................................................
Cheque ......................................................................................................................................
Telegraphic Money Order ..........................................................................................................
Bank Draft ..................................................................................................................................

12.

*If sent by Cheque indicate Cheque No ..........................................................................................................................

13.

Applicant's Signature .................................................................................................................... Date ......................

Copyright Ministry of Legal Affairs, Government of the Republic of Zambia

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