Rev. 2011]
Kenya Information and Communications
FORM NO. 4
CAP. 411A
Regulation 56
151
[Subsidiary]
COMMUNICATIONS COMMISSION OF KENYA
APPLICATION FOR INDIVIDUAL AUTHORITY TO USE TELECOMMUNICATION
TERMINAL EQUIPMENT
1.
PARTICULARS OF APPLICANT
(i)
Full names of Applicant/Company
………………………………………………………………….................
P. O. Box ……………………………… Tel No …………………………
(ii)
Physical Address where the equipment will be used
Town ………….. Road/Street/Estate …….…… Building ……………
(iii)
Details of Network in which the equipment is to be connected (i.e.
Radio/Data etc) ………………………………………………………......
(iv)
Type of service for which the equipment is intended to be used (e.g.
ISP access, Bureau, Residential voicemail, etc)
…………………………….……………………………. ……………
(v)
Telephone/Circuit number(s) to which the equipment will be connected
(where applicable)
……………………………………………………………..
2.
ITEM
NO
DESCRIPTION OF EQUIPMENT
TYPE
MANUFACTURER
3.
REQUIRED ITEMS
(i)
(ii)
(iii)
(iv)
(v)
MAKE AND
MODEL
SERIAL
NUMBER/IMEI
C O U N RT Y
OF
ORIGIN
Sample of equipment/instrument model complete with associated accessories
and attachments.
Technical Manuals (Operation, Programming, specifications).
Non–refundable approval/acceptance fee of Kshs ……….. vide Receipt
No…………… of ………………
Maintenance contract letter from registered Contractor (where applicable).
Copy of purchase/import ownership documents.