Application Form for VAS - Region 1
2
NTC Form No.: Reference No: APPL-I1 Republic of the Philippines NATIONAL TELECOMMUNICATIONS COMMISSION Agham Road, East-Triangle, Diliman, Quezon City APPLICATION FOR VAS REGISTRATION INSTRUCTfONS: All blanks must be filled up prcperty. Put "n/a" for items not applicabte to you. lJpon completion of the form submit this togetherwith reguired/supporting documents. Print all entries in block or CAPITAI LEIIERS tl tl tl New i----l Ren i-'---1 Modification L-----r a--___j WPE: 1 APPLICANT 2 BUSINESS ADDRESS 3 CONTAGT NO(s) 4 NTC PERMIT NO. 5 FRANGHISE (R.A.No.) EMAIL ADD.: VALIDITY z (lf Applicable) (lf Applicable) 6 TYPE OF FIRM: (Check appropriate box) j'----t i i Corporation l-----! ll i ! Single Proprietorship i-_--_j Partnership L-_--.! Others, please specify 7 HAS APPLICANT BEEN KNOWN BY ANOTHER NAME? l-----! Y€s i---l Nd lf Yes, Indicate the name(s) and address(es) of former name: 8 LIST OF VAS OFFERED : A B c D E F G 9 CERTIFICATION I HEREBY CERTIFY that all above entries are true and conect and that I shall be held liable for any willful false statements made in this application under the Revised Penal Code. Any false statement or misrepresentation made in connection with this application shall constitute a valid ground for the denial of this application andlor cancellation/ revocation of the permit to be granted. Authorized Representative Siginature over Pfinted Nanre of Applican't Date tl i AMoIJNT: i I It ll .l i-. i__-___-_._-___-____-c_49t!tF_F__-_-___--_._----_i PLEASE SEE BACK HEREOF FOR THE REQUIREMENTS TO BE SUBMITTED THIS FORM /S ruOl FOR SAIE AND CAN BE REPRODTJCED lKevtston No.; i F - - r--rr- ------ - -. _ -t iRevi6ion Oate. i r -- --r -- ----___-_ __ J
Transcript of Application Form for VAS - Region 1
NTC Form No.:
Reference No:
APPL-I1Republic of the PhilippinesNATIONAL TELECOMMUNICATIONS COMMISSIONAgham Road, East-Triangle, Diliman, Quezon City
APPLICATION FOR VAS REGISTRATION
INSTRUCTfONS: All blanks must be filled up prcperty. Put "n/a" for items not applicabte to you. lJponcompletion of the form submit this togetherwith reguired/supporting documents. Print allentries in block or CAPITAI LEIIERS
tltltl New i----l Ren i-'---1 ModificationL-----r a--___j
WPE:
1 APPLICANT2 BUSINESS ADDRESS3 CONTAGT NO(s)4 NTC PERMIT NO.5 FRANGHISE (R.A.No.)
EMAIL ADD.:VALIDITY z (lf Applicable)
(lf Applicable)
6 TYPE OF FIRM: (Check appropriate box)j'----ti i Corporationl-----!lli ! Single Proprietorship
i-_--_j Partnership
L-_--.! Others, please specify7 HAS APPLICANT BEEN KNOWN BY ANOTHER NAME?
l-----! Y€s i---l Ndlf Yes, Indicate the name(s) and address(es) of former name:
8 LIST OF VAS OFFERED :
AB
cD
E
F
G
9 CERTIFICATION
I HEREBY CERTIFY that all above entries are true and conect and that I shall be held liable for any willful falsestatements made in this application under the Revised Penal Code. Any false statement or misrepresentationmade in connection with this application shall constitute a valid ground for the denial of this application andlorcancellation/ revocation of the permit to be granted.
Authorized RepresentativeSiginature over Pfinted Nanre of Applican't
Date
tl
i AMoIJNT: iI
Itll.li-.i__-___-_._-___-____-c_49t!tF_F__-_-___--_._----_i
PLEASE SEE BACK HEREOF FOR THE REQUIREMENTS TO BE SUBMITTED
THIS FORM /S ruOl FOR SAIE AND CAN BE REPRODTJCED
lKevtston No.; iF - - r--rr- ------ - -. _ -tiRevi6ion Oate. ir -- --r -- ----___-_ __ J
DOC U M ENTARY REQU I REM ENTS FOR SUBIT''SS'OA'
NEW1 Duly accomplished Application form for VAS Application2 List and clescription of each of the value added services intended to be offered3 List of equipment and materials to be used for the system, including equipment to be inslalled, if any.4 Functional block diagram, system configuration and a brief description of the proposed system.
o Copy of any Interconnection Agreements needed to put the system into operation (Copies of Lease Agreement- with the Public Canier).
^ Certified True Copy of Securities and Exchange Commission Registration and Articles of IncorporationdDTlo
Permit.7 Latest Audited Financial Statement.I Schedule of Service Rates.
RENEWAL1 Duly accomplished Application form for VAS Application? Original'copy of eertificate'of VAS Registration'3 Latest schedule of Serviice Rates.
MODIFICATION1 Duly accomplished Application form for VAS Application2 Original copy of Certificate of VAS Registration3 Bescriptien.of.each.of'the value eddod services intende*to be otfered4 Lisil of equipment and materials to be used forthe system, including equipment to be installed, if any.
5 Funciional block diagram, system configuration and a brief description of the porposed system.
NTC REGIONAL OFFICE NO.:Office Address:Contact No.:Fax No.:E-mailAddress:
