LESOTHO COMMUNICATIONS AUTHORITY
Application for a Licence
Rule 59 of the LTA Rules of Practice, Procedure and Service Provision

Physical Address : 6th Floor, Moposo House, Kings way Road, Maseru Tel. + 266 22326784

Postal Address : LTA, P.O.  Box 15896, Maseru 100 Fax + 26622310984 e-mail lta@lta.org.ls   	
1.    PARTICULARS OF AN APPLICANT

1.1	PERSONAL PARTICULARS

Full Name of an applicant  _____________________________________________________________

___________________________________________________________________________________

Physical Address  ____________________________________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

Postal Address _______________________________________________________________________

____________________________________________________________________________________

Telephone Number  ____________________________________________________________________

Telefax  _____________________________________________________________________________

e-mail  ______________________________________________________________________________

1.2  State legal form of applicant e.g. company, trust, other _____________________________________
(attach copy of memorandum of articles of association, constitution or founding document certified by two office-bearers of the body)

1.3  If registered, office of registration _____________________________________________________

Registration No  ______________________________________________________________________

Date of registration  ___________________________________________________________________

 	

2.  SERVICE TO BE PROVIDED

2.1 Specify the required telecommunication service(s) to be provided

___________________________________________________________________________________
2.2 Specify the telecommunication system required to provide the service under 2.1

___________________________________________________________________________________

2.3	The physical location of your business  _______________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

3.  ACKNOWLEDGEMENT

3.1 The applicant acknowledges the statements in this form and accompanying documents will be relied upon by the Authority, and confirms that to the knowledge and belief of the applicant all such statements are true and correct.

3.2	The applicant undertakes to adhere to the terms and conditions of the licence as the Authority may prescribe.

Signature __________________________________________________________________________

Full names of signatory  ______________________________________________________________
                                                                Name of applicant