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GT Shield

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

Regulations

ICASA Compliance Procedure Manual Regulations, 2011

Forms

Form 5 : Tariff Reporting Form

 

FORM 5

TARIFF REPORTING FORM

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

 

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

 

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

 

1. Licence information

 

Name of Licensee

 


Licence/s held

 


Registration or ID Number

 


Date submitted

 


Period under review

 


 

2.        Tariffs (All data to be provided in 'Rand' value inclusive of VAT)

 

2.1        Prepaid Services - Mobile Voice

 

 RECORD OF PREPAID SERVICES PROVIDED AND ACTUAL SERVICES CHARGED DURING THE PREVIOUS SIX MONTHS

 



<Insert name of prepaid tariff plan>

 

 

 

Service

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

 

 

General

 

 

 

Billing method (per second or per minute)

 







Inclusive minutes (Value) and other benefits

 







 

 

Mobile to Mobile voice calls

 

 

 

 

 

On-net (peak)







On-net (off-peak)







Off-net (peak)







Off-net (off-peak)







 

Mobile to Mobile fixed voice calls

 

 

Off-net (peak)







Off-net (off-peak)







 

VAS Calls

 

 

Peak

 







Off Peak

 







 

 

Mobile to Mobile video calls

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

Mobile to fixed video calls

 

 

Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to Mobile SMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to fixed SMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to Mobile MMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

International mobile to mobile video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to fixed voice calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to mobile video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to fixed video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>







Voice calls (off-peak)

<please specify country or country grouping>







 

 

 

International mobile to mobile SMS

 

 

 

SMS (peak)

<please specify country or country grouping>

 







SMS (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to fixed SMS

 

 

 

SMS (peak)

<please specify country or country grouping>

 







SMS (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to mobile SMS

 

 

 

MMS (peak)

<please specify country or country grouping>

 







MMS (off-peak)

<please specify country or country grouping>

 







 

2.3        Top-up Contract - Mobile Voice and Data

 



<Insert name of prepaid tariff plan>

 

 

 

Service

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

 

 

General

 

 

 

 

 

 

 

 

 

 

 

Billing method (per second or per minute)

 







Connection fee

 







Call Line Identity

Presentation fee

 







Itemised Billing fee

 







Fixed monthly charge

 







Inclusive Minutes (Value) and other benefits

 







 

 

Mobile to Mobile  voice calls

 

 

 

 

 

On-net (peak)

 







Off-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

Mobile to fixed  voice calls

 

 

Off-net (peak)

 







Off-net (off-peak)

 







 

VAS Calls

 

 

Peak

 







Off-peak

 







 

 

 

Mobile to Mobile video calls

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

Mobile to fixed video calls

 

 

Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to Mobile SMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to SMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak

 







Off-net (off-peak)

 







 

 

 

Mobile to Mobile MMS

 

 

 

On-net (peak)







On-net (off-peak)







Off-net (peak







Off-net (off-peak)







 

 

Internet

 

 

Per MB (peak)

 






Per MB (off-peak)







 

 

 

International mobile to mobile voice

 

 

 

Voice calls (peak)

<please specify country or country grouping>







Voice calls (off-peak)

<please specify country or country grouping>







 

 

 

International mobile to fixed video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>







Voice calls (off-peak)

<please specify country or country grouping>







 

 

 

International mobile to mobile voice calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>







 

 

 

International mobile to fixed voice calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to mobile SMS

 

 

 

SMS (peak) <please specify country or country grouping>







SMS (off-peak) <please specify country or country grouping>







 

 

 

International mobile to fixed SMS

 

 

 

SMS (peak) <please specify country or country grouping>







SMS (off-peak) <please specify country or country grouping>







 

 

 

International mobile to mobile MMS

 

 

 

MMS (peak) <please specify country or country grouping>







MMS (off-peak) <please specify country or country grouping>







 

 

2.4        Prepaid and Postpaid Data

 

RECORD OF DATA SERVICES PROVIDED AND ACTUAL SERVICES CHARGED DURING THE PREVIOUS SIX MONTHS

 

Prepaid or Postpaid

 

Line Rental Fee

Bundle name

Bundle size

Monthly fixed charge

In-bundle rate

Out-of-Bundle rate

 

 







 

 







 

 

2.5        Fixed and VoIP Services

 



<Insert name of prepaid tariff plan>

 

 

 

Service

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

 

 

General

 

 

 

Billing method (per second or per minute)

 







Inclusive minutes (Value) and other benefits

 







 

 

Mobile to Mobile voice calls

 

 

 

 

 

On-net (peak)







On-net (off-peak)







Off-net (peak)







Off-net (off-peak)







 

Mobile to Mobile fixed voice calls

 

 

Off-net (peak)







Off-net (off-peak)







 

VAS Calls

 

 

Peak

 







Off Peak

 







 

 

Mobile to Mobile video calls

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

Mobile to fixed video calls

 

 

Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to Mobile SMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to fixed SMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

Mobile to Mobile MMS

 

 

 

 

On-net (peak)

 







On-net (off-peak)

 







Off-net (peak)

 







Off-net (off-peak)

 







 

 

 

International mobile to mobile video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to fixed voice calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to mobile video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>

 







Voice calls (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to fixed video calls

 

 

 

Voice calls (peak)

<please specify country or country grouping>







Voice calls (off-peak)

<please specify country or country grouping>







 

 

 

International mobile to mobile SMS

 

 

 

SMS (peak)

<please specify country or country grouping>

 







SMS (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to fixed SMS

 

 

 

SMS (peak)

<please specify country or country grouping>

 







SMS (off-peak)

<please specify country or country grouping>

 







 

 

 

International mobile to mobile SMS

 

 

 

MMS (peak)

<please specify country or country grouping>

 







MMS (off-peak)

<please specify country or country grouping>

 







 

 

2.6        Pay TV subscription tariff template

 


Period

Period

Period

Period

 

Name of package

 





Number of channels (attach a list and short description of the channels)

 





Monthly subscription fee

 





Connection fee

 





Re-connection fee

 





Fee per out-of-bundle channel(s)

 





 

 

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

 

4. Signature

 

 

Signature

 




 

Designation

 


 

Date