APPLICATION FORM

Internet Protocol Telephony Service Provider (IPTSP) License Application

A. Applicant Profile:

B. Details of Existing ISP License:

C. Business Activities:

D. Following Documents are Also to be Duly Certified and to be Attached with the Application Form:

E. Declaration:

1. Has any Application for License of the Applicant/any Share Holder/Partner ISP been rejected before? [] Yes [] No

If yes, please provide date of application and reasons for rejection:

___________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Do the Applicant/any Share Holder/Partner hold any other Operator Licenses from the Commission? [] Yes [] No

If yes, please give details ___________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. Has any other License of the Applicant/any Share Holder/Partner been rejected before?

[] Yes [] No

If yes, please provide date of application and reasons for rejection: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Do the Applicant/ its owner(s)/ any of its director(s)/ partner(s) were involved in any illegal call termination using VoIP technology? [] Yes [] No

If yes, please provide the following details:

i. Period of Involvement in illegal VoIP activities: ____________________________

ii. Case No (If Applicable): _______________________________________________

iii. Administrative fine paid to the Commission (If Applicable):

a. Amount (BDT): _________________________________

b. Cheque No./ Bank Draft No.: _______________________

iv. Undertaking given to the Commission: [] Yes [] No

5. 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.

6. I/We hereby certify that I/We have carefully read the section 36 of Bangladesh Telecommunication Act, 2001 and I/We are not disqualified from obtaining the License.

7. 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 Bangladesh Telecommunication Act, 2001.

Signature

Name of the Applicant/Authorized

Signatory with Seal

Date:

Place:

Note:

§ Application without the submission of complete documents and information will not be accepted.

§ Payment should be made by a Pay order / Demand Draft in favor of Bangladesh Telecommunication Regulatory Commission (BTRC).

§ Application fee is not refundable.

§ Application will not be accepted if information‟s do not fulfill the relevant terms and conditions of the Commission issued at various time.

§ Any ISP found involved with illegal VoIP business at any time shall not be eligible for any type of IPTSP License.

PERFORMANCE BANK GUARANTEE

[Non-Judicial Stamp]

[Date]

[Name of Bank] (Hereinafter called the Bank)

[Address]

To: The Bangladesh Telecommunication Regulatory Commission.

[Address]

Dear Sirs

Subject: Bank Guarantee No.: dated: for Tk. ……………………………. (Taka ……………………………………….) (BDT …………………………) only in favour of “The Bangladesh Telecommunication Regulatory Commission” as security deposit.

This Bank Guarantee (hereinafter called the Guarantee) is issued pursuant to the clause…………….. of the license no. ……………………………. dated ………………………. for operating and maintaining of Internet Protocol Telephony Services in the country granted to ………………………………………….(hereinafter called the licensee) by the Bangladesh Telecommunications Regulatory Commission (hereinafter called the Commission) under the Bangladesh Telecommunication Act, 2001.

This Guarantee will serve as security deposit for fulfillment of Licensee‟s obligations under the terms and conditions of the License.

The Bank hereby irrevocably guarantees and undertakes to pay to the Commission, any or all sums up to the amount stipulated in Form-1 and annexed hereto and in accordance with the following terms and conditions:

(a) Payment shall be made by the Bank within the same business day of the receipt of any written demand by the Commission;

(b) The written demand by the Commission is made substantially in the form annexed as Form-3 and executed by an authorised representative of the Commission;

(c) Payment shall be made unconditionally and without reservation including the need for any reference to a third party or the Licensee and without the need for any evidence or proof;

(d) Payment is to be made in Taka by crossed cheque in favour of:

The Bangladesh Telecommunication Regulatory Commission

This Guarantee is irrevocable and shall remain in force for 5 (five) years from the date hereof.

The Bank shall not be discharged or released from its obligations under this Guarantee unless it has paid any or all sums up to the amount as stated in Form-1 and Form-2 or the Licensee has achieved all its targets under terms and conditions of the license and this has been confirmed in writing by the Commission.

This Guarantee shall be governed and construed in accordance with the relevant laws of Bangladesh.

Signed by,

(Full name and designation)

_________________

for and on behalf of:

____________________

Name of Bank

Witnessed by:

__________________

Signature

____________________________________

Name in full

Father‟s name

_________________________________________________

Address

Date

Address:

BANGLADESH TELECOMMUNICATION REGULATORY COMMISSION

IEB Bhaban, Ramna, Dhaka-1000