FORM-NTC:ISP
APPLICATION FORM FOR INTERNET SERVICE PROVIDER (ISP) LICENSE
(Application to be submitted in triplicate).
NEW RENEWAL
A. Application Profile
1. Name of Entity:
Registered Office Address
Telephone & Mobile
Fax
Website
Email
2. Name of Contact Person:
Full Address for
Communication
Telephone & Mobile
Fax
Website
Email
3. Type of ISP: [ ] Nationwide [ ] Zonal
a. Zone: [ ] Central Zone [ ] North-East [ ] South-East [ ]South-West
b. Coverage Area: (Districts Name Only)
B. Service Profile (Application for Renewal)
1. Location of Installation:
2. Date of Commencement of the Service: __________/_________/_____________
Day Month Year
3. Application for the period: __________/_________/___________ To _________/_________/_________
Day Month Year Day Month Year
FORM-NTC:ISP
4. Number of date of License of which renewal is sought for:
License Number & Date:
5. a. Number of Clients/Users of Internet:
Home: Office: Cyber Café Others:
b. Number and list of Clients/Users of domestic point data connectivity:
Corporate User: Branch User: Personal User:
C. Technical Profile
1. Type of Service: [ ] Dial-up [ ] Wireless [ ] Wired (optical/copper)
a. Dial Up
Number of telephone lines provided by the PSTN: Access Code:
b. Wireless
Number of BTS/PoPs: Frequency: /
c. Wired
Length of laid cable: Km DSL ADSL Optical Fiber UTP STP
2. Bandwidth: [ ] IIG [ ] Sublease
Provider: Allocation: Up - Down -
Medium:
Backup: Allocation: Up - Down -
Medium:
Frequency:
(If medium is authorized VSAT, Please mention frequency)
3. Disaster Recovery Center/Data Center:
Address of Installation:
Connectivity Allocation: Up - Down -
Provider Medium:
(If medium is authorized VSAT, Please mention frequency) Frequency: Up - Down -
D. Pay Order/Bank Draft Details
Type of Payment: [ ] P.O [ ] D.D
a. Name of Bank :
b. No.: c. Date :
FORM-NTC:ISP
E. Documents to be Enclosed for New ISP License:
Use tick [ √ ] mark in the appropriate box
Serial Items Attached Not Remarks
attached
1. Application in a Letter Head Pad
2. Relevant Fees in the form of Pay Order/Bank Draft
3. Agreement with the bandwidth provider (IIG/Sublease)
4. House-Rent Agreement/Ownership deed
5. Description of existing business
6. Bank Solvency Certificate
7. Documents for financial capability to run the business
8. Undertaking about not as a Bank Defaulter
9. Certificate of Incorporation (if applicable)
10. Memorandum & Articles of Association (if applicable)
11. Trade Licence
12. Network Diagram in details
13. Equipment List
14. Business Plan
15. Proposed Tariff Chart
16. Latest Income Tax Clearance Certificate
17. Information with relevant documents regarding the amount
of VAT and Income Tax that the company has deposited to
the Government fund for the last 3 (three) years.
for Renewal of ISP License
Use tick [ √ ] mark in the appropriate box
Serial Items Attached Not attached Remarks
1. Application in a Letter Head Pad
2. Relevant Fees in the form of Pay Order/Bank Draft
3. Statement of Payment to the Bandwidth Provider
4. Declaration about not as a Bank Defaulter
5. Trade Licence (updated)
6. Expanded Network Diagram in details
7. Equipment List (for expansion)
8. Internet Clients/Users List (wireless/wired)
9. Clients/Users list of Domestic point to point data connectivity
10. Tariff Chart (approved by the Commission)
11. Statement of payment for the preceding year made to the
satellite company through the local bank transaction for
VSAT (if applicable)
12. Statement of payment for the Radio Station & Frequency
Charge given to the Spectrum Management Division of the
Commission
13. Total Investment in details
14. Latest Income Tax Clearance Certificate
15. Information with relevant documents regarding the amount
of VAT and Income Tax that the company has deposited to
the Government fund for the last 3 (three) years
16. Bank Solvency Certificate
FORM-NTC:ISP
F. Declaration:
1. Has any Application for License of ISP been rejected before? Yes No
(if yes, please give date of application and reasons for rejection)
2. Has any license issued previously to the Applicant/any shareholder/partner been cancelled?
Yes No (if yes, please give details)
3. Do the Applicant/any Shareholder/Partner hold any other Operator Licenses from the Commission?
Yes No (if yes, please give details)
4. I/We hereby certify that I/We have carefully read the guidelines/terms and conditions, for the license and I/We
undertake to comply with the terms and conditions therein.
5. I/We hereby certify that I/We have carefully read the section ………………………. Of the Act, 2006 as Amended 2009
and I/We are not disqualified from obtaining the license.
6. I/We understand that if at any time any information furnished for obtaining the license is found incorrect then the
license if granted on the basis of such application shall deemed to be cancelled and shall be liable for action as per
Telecommunication Act, 2006 as Amended 2009
Signature Date
Place:
Name of the Applicant/Authorized Signatory with Seal
Information
_____________________________________________________________________________________________________
ISP Category Information:
Nationwide Central Zone South-East Zone North-East Zone South-West Zone North-West Zone
Anywhere within the Country Tonkolili Kenema Makeni Moyamba Port Loko
Kailahun Koinadugu Rotifunk Kambia
Kono Schenge
Pujehun
Note:
No application for renewal of license shall be entertained beyond 90 days of the expiry of the year of license concerned and the license
shall then stand cancelled and penal action shall follow if the licenses continue his business thereafter without valid license. The
charges/fees/fines upto 90 days if not paid shall be recoverable under the Public Demand Recovery Act, …..
The Fees/Charges are given in circular which is given in the website ([Link] )
Application without the submission of complete documents and information will not be accepted
For Renewal, please attached a photocopy of the existing license
Payment should be made by a Pay Order/Demand Draft in favour of National Telecommunications Commission (NATCOM)
The Form fee and Evaluation fee (if applicable) is not refundable