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

Regulations

Licensing Processes and Procedures Regulations, 2010

Forms

Form O : Notice of change of information in respect of an Individual Licence

 

Form O

 

Notice of Change of Information in respect of an Individual Licence

 

(Regulation 14A)

 

Independent Communications Authority of South Africa

 

Note:

(a) Applicants must refer to the Electronic Communications Act, 2005 (Act No. 36 of 2005) ("the Act") and any regulations published under that Act with regard to the requirements to be fulfilled by applicants.
(b) Licensees must refer to the Electronic Communications Act, 2005 (Act No. 36 of 2005) ("the Act') and any regulations published under that Act with regard to the requirements to be fulfilled by licensees.
(c) Information required in terms of this Form which does not fit into the space provided may be included in an appendix attached to the Form. Each appendix must be numbered with reference to the relevant part of the Form.
(d) Where any information in this Form does not apply to the licensee, the licensee must indicate that the relevant information is not applicable.

 

1. PARTICULARS OF LICENCE
1.1 Licence number:
1.2 Attach a copy of the Licence that is the subject of this notice, marked clearly as Appendix 1.2 of FORM O.

 

2. CHANGE OF INFORMATION PROVIDED IN THE REGISTER
2.1 Indicate whether the updated information relates to:

 
2.1.1 Name and contact details of the licensee; and/or:

 
2.1.2 Nature of the service provided by the licensee:

 

 

3. PARTICULARS OF LICENSEE

 

 
3.1 Licensee must provide the information requested in this section even where no change has occurred in relation to the licensee's particulars.

Indicate with an X where there is change
3.2 Full name of licensee:

 

 

3.3 Designated contact person:

(1)

3.4 Designated contact person:

(2)

3.5 Licensee's street address:

 

 

3.6 Licensee's principal place of business (if different from street address):

 

 

3.7 Licensee's postal address:

 

 

3.8 Licensee's telephone number/s:

 

3.9 Licensee's mobile number/s:

 

3.10 Licensee's telefax number/s:

 

3.11 E-mail address of designated contact person: (1)

 

3.12 E-mail address of designated contact person: (2)

 

3.13 Shareholding (A signed letter with the breakdown of the shareholding structure to be changed as Attach as Appendix 3.13):


 

4. NATURE OF THE SERVICES PROVIDED BY THE LICENSEE

Where the nature of the services provided by the licensee in terms of the licence has changed, provide updated information on the nature of the service provided:

 

 

 

 

 

 

5. GENERAL
5.1 Provide details of any matter which, in the licensee's view, the Authority should consider: (e.g. shareholding by HDI/HDG/HDP; women; youth; people with disabilities).

 

 

 
5.2 Attach a resolution authorising the person signing this notice. The resolution must be signed by the contact person as per the licence. The resolution must be clearly as Appendix 5.2.of FORM O.

 

 

 
5.3 Notifications for change of name must be accompanied by CIPC registration documents. Attach as Appendix 5.3 of FORM O.

 

 

 

 

 

The person signing the registration on behalf of the applicant must acknowledge as follows:

 

I acknowledge that the Authority reserves the right to have any licence amended pursuant to this notice set aside should any material statement made herein, at any time, be found to be false.

 

 

Signed: ............................................................   (LICENSEE)

 

 

I certify that this declaration was signed and sworn to before me at .............................. on the .......... day of  ............................... 20......, by the deponent who acknowledged that he/she:

• knows and understands the contents hereof;
• has no objection to taking the prescribed oath or affirmation; and
• considers this oath or affirmation to be truthful and binding on his/her conscience.

 

 

                                                                             

 COMMISSIONER OF OATHS

 

Name:

 

Address:

 

Capacity:

 

[Form O substituted by regulation 8 of Notice 154 of 2016, GG 39871, dated 30 March 2016]