APPLICATION FORM REGISTRATION FORM FOR INTERNET SERVICE PROVIDERS

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code / Zip

Country

Name of Company:

Nationality:

Telephone

Particulars of the services provided

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

N.B. At present there is no registration fee but there will be a licence fee when the new Telecommunications Act is in force.