Independent Communications Authority of South Africa Act, 2000 (Act No. 13 of 2000)

Regulations

Purchase

FORM 11

JUDGEMENT FOR

(I-BS and C-BS)

This Form must be submitted in accordance with the Regulations Regarding Standard Terms and Conditions.

1. Licence information

2. Judgement against:

a. Licensee? Yes/No

b. Director? Yes/No

Name
ID Number

c. Senior management? Yes/No

Name
ID Number

3. Conviction (Description):

4. Date of Conviction:

5. Case Number & Court:

6. Sentence:

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

Signature

Signature
Designation		Date