Electronic Communications Act, 2005 (Act No. 36 of 2005)

Regulations

Name of

Educational

Institution

Date of Contract signature

Services provided

City / Province

Effective date

Reasons for Service cancellation

If service cancelled, date resumed

Purchase

FORM 4

E-RATE FORM

(I-ECS, I-ECNS, C-ECS and C-ECNS)

This Form must be submitted in accordance with E-Rate regulation published in terms of section 73 of the Act.

This Form should be submitted bi-annually in accordance with the Authority's Financial Year.

1. Licence information

2. The following table must be completed by all licensees providing services at E-rate:

3.	I, ......................................................................., in my capacity as ...............................................................hereby verify that the information provided is true and correct.

4. Signature

Signature

Designation

Date