Inspection Schedule of Licensee (UL- AS)
Government of India
                 Ministry of Communications and Information Technology
                            Department of Telecommunications
                                   _________________LSA
                            Address: __________________________
                            ___________________________________
                            ___________________________________
                  Inspection Schedule of Licensee (UL-Access Service)
Instructions:
1.To    be filled by the Nodal Officer or Authorized signatory.
2.All   pages must be signed.
3.Attachments    shall be provided in softcopies in CDs/DVDs/Pen drive. All PDF
  files shall be signed (Digitally or ink signed)
4.File   types should be Excel, Word, or Plain text only. Large files may be zipped.
5.If document(s) mentioned here have been submitted already during earlier
  inspections, same need not be submitted again, and a proper remark may be
  placed against that particular point here.
         Signature _________________________________                                Page 1 of 19
                                                                Inspection Schedule of Licensee (UL- AS)
A. General
1.   Name of the Licensee. ________________________________________________________
2.  License           No.                         ______________________________                Dated.
 ______________________________
(Copy of license to be submitted)
3.   Service Areas _______________________________________________________________
4.   Name, designation and contact details of the Authorized Signatory:
 _____________________________________________________________________
 Tel No.________________________                Mobile No.: ______________________
 E-mail Id. _____________________
5.   Name, designation and contact details of the Nodal Officer:
 _____________________________________________________________________
Tel No.________________________                 Mobile No.: _________________________
E-mail Id. _____________________
6.   Services offered: Please tick whichever is applicable
      Sl                    Service Name                       Yes/No         Name of Service (If
                                                                                 applicable)
      1      Wireline telephone
      2      Wireless/Mobile telephone
      3      Non-Voice Messaging (SMS)
      4      Internet Services
      5      Internet telephony
      6      Leased circuits
      7      VPN
      8      National/International Roaming
      9      Voice Mail
     10      Email
     11      Audiotex
     12      Video Conferencing
     13      CUG
     14      Voice chat
           Signature _________________________________                                       Page 2 of 19
                                                        Inspection Schedule of Licensee (UL- AS)
     15     Broadband
     16     Broadband VAS (Pl Specify)
     17     3G Service
     18     3G VAS (Pl specify)
     19     3G Fax
     20     Location Based Services (LBS)
     21     Data Services (WAP/GPRS/EDGE)
              (PL MENTION)
     22     IN Services
     23     EVDO/WLL Services
     24     IP TV
     25     Audio Conference
     26     Mobile Number Portability (MNP)
     27     GSM PCO
     28     CDMA/WLL PCO
     29     Unified Messaging Service
            (Voice Mail/FAX Message/
              Email/Email To Speech)
     30     MMS (Multimedia Messaging
              Service)
     31     Web Co-Location Services
     32     Web HOSTING
     33     BULK SMS
     34     Wi-Fi Hot spots
     35     Other services offered in the
              License Area
     36     Any other types of VAS
7.   Supplementary Services (please tick on the services being provided)
      S                     Service Name                Yes/No         Name of Service
       N                                                                (If applicable)
       o
      1      Calling Number Identification
              Presentation
      2      Calling Number Identification
              Restriction
      3      Connected Number Identification
              Presentation
      4      Connected Number Identification
              Restriction
      5      Malicious Call Identification
      6      Call Forwarding Unconditional
      7      Call Forwarding on Mobile
              Subscriber Busy
      8      Call Forwarding on No Reply
      9      Call Forwarding on Mobile
          Signature _________________________________                                Page 3 of 19
                                                        Inspection Schedule of Licensee (UL- AS)
              Subscriber Not Reachable
     10      Call Transfer
     11      Mobile Access Hunting
     12      Call Waiting
     13      Call Hold
     14      Completion of Call to Busy
              Subscriber
     15      Three Party Service
     16      Conference Calling
     17      Closed User Group
     18      Advice of Charge
     19      Free phone Service
     20      Reverse Charging (Called or Calling
              MS)
     21      Barring of All Outgoing Calls
     22      Barring of Outgoing International
              Calls
     23      Barring of Outgoing International
              Call except those directed to the
              Home PLMN Country.
     24      Barring of All Incoming Calls
     25      Barring of All Incoming Calls when
              Roaming Outside the Home PLMN
              Country.
     26      Unstructured supplementary
              services data.
     27      Videotext and Facsimile
     28      Other Services, if any
8.  If there is only one switch to perform functions of ILD / NLD / Cellular / Basic
 and located at same station then whether the separate accounts of all the
 operations are maintained or not.
9.   Self-Certificate for the adherence to the National Fundamental Plan and
 technical standard as prescribed from time to time by DoT in this respect.
          Signature _________________________________                                Page 4 of 19
                                                                      Inspection Schedule of Licensee (UL- AS)
        B. Technical
        (Details in the mentioned formats may be provided in a CD)
        1.      Detailed Network Diagram for 2G/3G/4G showing Interconnectivity
         between (mentioning Location, Bandwidth) all network elements like
         LR//IN/MME/ GGSN/SGSN/SMSC/MMSC
         /APServer/EIR/BSC/UMS/LBS/NGN/RBT/SSTP/MGW/GMGW etc. and MSC.
        2.        Equipment and Connectivity
         a.   Network Equipment – MSC / MGW /MME/ Wire line Switch
     Sl. Locatio MSC          Manufactured Commissioned               VLR     SP     GT      SW    REMARK
      N     n     /MG          by           Date                       Cap     Co     Co     Versi    S
      o.          W                                                   acity    de     de      on
                  /MM
                  E
        b.    Network Equipment – BSC / RAN
S    Locati   Parent     Manufa         MO      Commis        Capa    SW      Media        Band     Rem
 l     on      MSC        cture          D       sioned        city    Ve      of           widt     ark
 .             /MG        d By           EL       Date                 rsi     conne        h of     s
                 W                                                     on      ctivity      medi
 N                                                                                          a
 o
 .
        c.    Network equipment – BTS / Node-B/e-NodeB
        S Loca     Paren       Manu       SACFA          Commi     Capacit    Self-        SW      Media          Re
        l. tion    t BSC       factur     Clearan        ssioned   y(In       Certifie     Versi   of             m
        N                      ed By      ce             Date      Erlangs)   d/           on      conne          ar
        o                                 (Yes/No)                 /BW in     TERM                 ctivity        ks
                                                                   Gbps       (LSA)
                                                                              Certifie
                                                                              d
        3.        Interconnection within same operator:
                Signature _________________________________                                        Page 5 of 19
                                                                          Inspection Schedule of Licensee (UL- AS)
From           To      Type of traffic          Type of         Related     TGP        %                 Remarks
                        (Access/NLD             signallin         ASR        Nam        utilization
                       /ILD/Others)                 g                        e          /
                                                                                        rejections
4.                 Interconnection with other operators:
 Name of                Fro      To        Type of           Type of           CCR        Action by the
   MSC                   m                  traffic          Signalling                    Licensee for
                                                                                           augmenting the
                                                                                           capacity, if
                                                                                           required
Fro        T           Type of traffic            Type of      CCR        Relat   TGP     %             Remar
 m             o     (Access/NLD/ILD/              signa                    ed     Na      utilizati     ks
                           Others)                  lling                  ASR     me      on/
                                                                                           rejectio
                                                                                           ns
     5.            Direct connectivity to MSC / GMSC (Switching Nodes) of other operators
6.                 Frequency Band allocated
     Name of TSP                 UPLINK          DOWNLINK            BAND                  Services
       (Original                                                                      (GSM/3G/CDMA/4G)
       Licensee)
7.                 Additional Spectrum being used
     Name of TSP                 UPLINK         DOWNLINK             BAND                  Services
       (Original                                                                      (GSM/3G/CDMA/4G)
       Licensee)
8.            Consolidated Traffic Report of all MSC/MSC Server /S-GW in the network
          during Time Consistent Busy Hour (TCBH) for One Week (As per Annexure-1)
               Signature _________________________________                                             Page 6 of 19
                                                               Inspection Schedule of Licensee (UL- AS)
9.        Radio Performance Report during Time Consistent Busy Hour, BSC /RNC
      wise for one week. (AS per Annexure -I).
10.        Count of subscriber as per billing system, IN, HLR / HSS and VLR/MME
      including roaming subscribers. (Screen shots of system terminal as proof)
11. What is the purging period for VLR/MMEdata base (is it 72 hours?)
12. The numbers allocated and VLR/MME Figure (V) as percentage of number
       allocated (V/N)?
13. Routing Analysis Table. of switch, Router configuration files of all the
 Major/Core routers.
14. Sub’s terminal equipment’s provided, Make /model and certifications (including
 Dongles) by the operator.
       Sl.   Equipment           Make           Model     Whether MTCTE           If yes, MTCTE
        No                                                 compliant                Certification
         .                                                                          No/Date
15.      Sample of subscriber information/services as available in HLR /HSS                            &
      VLR MME. (Screenshots from HLR/HSS & VLR/MME)
16. Sample of subscriber information/services as available in IN. (Screenshots from
 IN).
17. Core Network Equipment’s (4G/3G/2G) as in the format.
      Sl.    Name Of               Manufactured         Installation           LSA /          Quantity
      No.     Equipment                 By                Date                Location
18.       Submit the copy of Acceptance test for interconnectivity carried out for each
      and every interface with any service provider.
19.       Whether domestic traffic is routed through any switch/system located
      outside India?
         Signature _________________________________                                        Page 7 of 19
                                                                    Inspection Schedule of Licensee (UL- AS)
20. SACFA Clearance details for various point to point radio links.
              Address of the          Height of Tower/ Frequency of             Power Radiated        SACFA
      Sl.
              Radio Link              building         Operation                by the Radio          ID/
      No.                                                                                             SACFA
                                      (GBT/RTT) in                              Equipment             Cleara
                                      Mtrs                                      (in Watts)            nce
                                                                                                      Obtain
             A End       B End       A End       B End      A End     B End     A End      B End
21.      Whether limited mobility subscribers and WLL subscribers are restricted to
      SDCA and subs premises respectively?
22.        Please furnish the total count of mobile numbers ported in and ported out
      till date. Also furnish the list of rejected cases along with the reasons for
      rejection in the last 3 months.
            Total Ported OUT                Total Ported IN                     Net Ported Numbers
                 Numbers                     Numbers
23.          Numbering Series allotted.
      CCITT E.164 Number                Country           National                  SN         SN Range
       series                            Code(CC)         Destination Code         Range          Stop
      MSISDN Number                                       (NDC)                    Start
       Range(s):
24.          M2M Numbering Series allotted for __________ LSA
      Sl. No             M2M identifier          SN range Start       SN range Stop        Remarks
            Signature _________________________________                                          Page 8 of 19
                                                                   Inspection Schedule of Licensee (UL- AS)
25.        Compliance on MTCTE as per the DoT / TEC guidelines issued from time to
       time.
        Sl.      Equipment              Make               Model          Whether         If yes, MTCTE
        No.                                                               MTCTE             Certificate
                                                                          compliant         No/Date
26.           Status of IPv6 implemented as per DoT guidelines for:
      i. Core Network
      ii. Subscriber Terminals (CPE)
27.           Net Neutrality:
       i)     Whether the Licensee is compliant to Net Neutrality as per the guidelines issued
                by DoT from time to time. Yes/No.
       ii)    If No, provide reasons for non-compliance:
             Signature _________________________________                                        Page 9 of 19
                                                                  Inspection Schedule of Licensee (UL- AS)
C. Security
1.        Any BTS / NodeB/eNodeB emanating                      signal   which    are   useable      near
          international Border? (Yes/No)
2.         Any bulk encryption equipment employed in the network? (Yes/No)
3.        Encryption: List of Customers using encryption
     Sl.      Name of           Address                Whether permission      Whether decryption
      No.      the                                      has been taken          key, split into two
               Customer                                 from Telecom            parts, has been
                                                        Authority               deposited with the
                                                                                telecom Authority
4.         Arrangement of Lawful interception and monitoring facility.
     Sl                                Monitoring                                           Yes/No
     1     At least 480 simultaneous calls with at least 30 simultaneous
             calls for each of the designated LEAs. Each MSC in the
             service area shall have the capacity for provisioning of at least
             3000 numbers for monitoring
     2     Tracing facility for malicious calls
     3     Tracing facility for messages
     4     Tracing facility for Foreign in-roamers
     5     Interception of Speech
     6     Interception of SMS
     7     Interception of DATA (GSM, CDMA,3G,4G)
             (GPRS/EDGE/3G/EVDO)
     8     Interception of all VAS
     9     Interception of Video Calls
5.   Details of foreign personnel deployed for Operation and maintenance and their
 security clearance from Ministry of Home Affairs.
6.   Name of National Roaming Partners and International Roaming partners and a
 sample copy of agreement.
7.   Details of NLD and ILD partners and a sample copy of agreement.
             Signature _________________________________                                       Page 10 of 19
                                                        Inspection Schedule of Licensee (UL- AS)
8.    Availability of Complete list of subscribers including their name and address on
      password protected licensee’s web site. (Website ID & Username/Password for
      same)
       URL of the web site:
       User Name:
       Password:
9.     Any guideline issued by Licensee to prevent misuse of CLIR facility. Availability
      of CLIR Subscriber on password protected websites with their complete address
      details. (Website ID & Username/Password for same).
10.   Record of Periodic inspections of Bulk user/Audiotex License holders’ premises
      by Service Providers for checking their bonafide and to detect the misuse of such
      connections or leased circuits. (SAMPLE CASES SHOULD BE ATTACHED AS
      “BULK INSPECTION”)? to check the format
11.   Record of Periodic inspections of Leased circuits user’s Including Audiotex
      License Holders premises by Licensee for checking their bonafide and to detect
      misuse by the Customer. Inspection reports to be cross checked. (Sample Check
      of Customers will be accompanied by Licensee)
12. CDRs   are being stored for Two years. Yes/No. (Sample to be provided).
13. Whether   analysis of CDRs for heavy users are being done? Copy of the reports
      submitted during the last quarter to Security unit to be furnish.
14. Whether    analysis of CLI and detection of improper CLIs is being done? Copy of
      detected cases in the last quarter to be submitted to Compliance.
15. What is the procedure being followed to update the EIR periodically?
16. What steps are being taken to prevent IMEI cloning?
          Signature _________________________________                                Page 11 of 19
                                                           Inspection Schedule of Licensee (UL- AS)
  17.     Whether calls with unauthorized IMEI, without IMEI or all zero IMEI are being
         checked and rejected?
  18. ILL   Customers:
   i.   Whether licensee is obtaining compliance from its ILL customers that they
    maintain the usage of IP addresses/Network Address Translation (NAT) syslog, in
    case of multiple users on the same ILL, for a minimum period of one year as per
    the directions/instructions issued by the licensor from time to time? (Yes/No)
  ii.     Whether the licensee has entered into an agreement with each ILL customer
          which clearly mentions the activities that are prohibited. (Yes/No)
 iii.     Provide the sample copy of agreement with ILL Customers along with
        a. Network Diagram showing required details of the setup at ILL Customer
          premises
        b. Details of other communications links (PSTN, NLD, ILD, WLL, GSM, other
          licensee etc.) and reasons for taking the link by the customer.
  iv.     List of Inspections carried out by the licensee on their ILL customers in last one
          year. Sample inspection reports to be submitted
   v.     Whether the Licensee has detected any misuse of Internet Leased Line? (Yes/No)
  vi.     If yes, provide the details of action taken by the Licensee against the subscriber.
  19. Audiotex    license customers
 i.      Whether licensee is obtaining compliance from its Audiotex licensee customers
         that they maintain the usage of IP addresses/Network Address Translation
         (NAT) syslog, in case of multiple users on the same ILL, for a minimum period of
         one year as per the directions/instructions issued by the licensor from time to
         time? (Yes/No)
ii.                                                         Whether the licensee has
         entered into an agreement with each Audiotex licensee customer which
         clearly mentions the activities that are prohibited. (Yes/No)
iii.                                                      Provide the sample copy of
         agreement with Audiotex licensee Customers along with
   Pl note:-
  1.     Network Diagram showing required details of the setup at ILL Customer
    ( Audiotex licensee customer) premises.
  2.     Details of other communications links (PSTN, NLD, ILD, WLL, GSM, other ISP
   etc.) and reasons for taking the link by the customer.
             Signature _________________________________                                Page 12 of 19
                                                            Inspection Schedule of Licensee (UL- AS)
iv.     List of Inspections carried out by the Li cens e e on their all Audiotex licensee
        Customers in last one year. All inspection reports to be submitted.
v.                                                       Whether the Licensee has
        detected any misuse of Internet Leased Line? (Yes/No)
vi.                                                        If yes, provide the details of
        action taken by the Licensee against the Audiotex License holder.
20. Names and Nationalities of Officers in key positions, and clearance from Ministry
  of Home Affairs if the officer is a foreigner.
                           Position                      Nationality       Clearance from
                                                                            MHA (Yes/No)
      Chairman
      Managing Director
      Chief Executive Officer
      Chief Technical Officer
      Chief Security Officer
      Chief Financial Officer
      Officer In charge of Lawful interceptions
21. A   list of Directors and their Nationalities.
22. Details   of the system for enabling lawful interception from a centralized location.
23. Details   of BULK SMS provision process.
24. Whether CDR contains all the parameters as per the latest instructions of DoT?
  Provide sample copy of CDRs of test numbers.
25. What is the present methodology adopted to communicate the location based
  information to LEAs?
           Signature _________________________________                                   Page 13 of 19
                                                                Inspection Schedule of Licensee (UL- AS)
26.Details of the Nodal officer appointed for Trusted Telecom Portal ,submitted to the
Designated Authority i.e National Cyber Security Coordinator ( copy of the letter
shall be enclosed)
    Sl Item                                           Details
    No
    1    Name of the Nodal officer
    2    Designation
    3    Date of Submission to the
         Designated authority
    4    Copy of the Nomination letter
         enclosed ( YES/NO)
  27. Compliance on Trusted Sources as per the DoT /Designated Authority directions
issued from time to time
S Equipment       Make       Model Whether Equipment is     Whether permission has
                                     designated as “Trusted   taken for
                                     Product or not” by the   upgradation/expansion
                                     Designated authority     of equipment which was
                                   ( Yes/No)                  not designated as
                                                              Trusted Product.
                                                            Details of the permission
                                                              along with the copy
                                                            (YES/NO/Not Applicable)
 28. Whether Licensee is submitting the compliance letter regarding compliance of all
conditions (format enclosed in the annexure) on 1 st day of January and 1st day of
July of every year to the Licensor? (Yes/NO). (The compliance letter is to be given by
authorized signatory of the Licensee Company as per the DoT Ltr No 20-1236/2021-
AS-I dated 5th July 2021) . Copy enclosed at Annexure ‘II’
   a. Please enclose the copy of the first and latest 2 compliance letters submitted.
        Signature _________________________________                                          Page 14 of 19
                                                           Inspection Schedule of Licensee (UL- AS)
D. Operations
1.      Average time taken for provisioning of new connection.
2.      Details of all emergency, public utility services and helpline to its subscribers.
1.       List of National specific level 1 Short Codes
       Sl No         Short code           Name of service                Remarks
2.      List of State Specific level 1 Short Codes
       Sl No          Short code         Name of service                 Remarks
3.   Provide the list of A u di o t ex Li c ense ho l der s , those are being provided with
 telecom resources, as per the following format.
    Sl. Name of        Address          Type of       Details      Audiotex       Remarks
      N Audiotex                          service      of BW/       License No.
      o. Licensee                         provided     Plan         with date
4.    Copy of QoS Reports submitted in last two Quarters to TRAI. (Performance &
     Inter-Operator minutes of O/g and I/c traffic) (AS PER FORMAT)
5. Details  on Public Grievance redressal Mechanism and their redressal policies.
     What is the MTTR? Please furnish last three months figure (ENCLOSE THE
     METHODS IN FLOW CHART PATTERN)
6. Contracts    entered into with CMTS Provider and other Licensed Telecom Service
     Provider for sharing of infrastructure /backbone. Whether copy of all such
     contracts submitted to Licensor. (Attach sample Copy)
7. Contracts  entered NLD and ILD Licensees for sharing of infrastructure /backbone.
     Whether copy of all such contracts submitted to Licensor. (Attach Sample Copy)
      Sl No    Nature of                     Name of    Period of           Date of
                Contract                     NLD/ILD     contract           submission of
                                             Provider                       the Copy of the
                                                                            contract to DoT
          Signature _________________________________                                   Page 15 of 19
                                                               Inspection Schedule of Licensee (UL- AS)
8. Contracts entered with Infrastructure Providers (IP-I) for sharing of infrastructure
 /backbone. Whether copy of all such contracts submitted to Licensor. (Attach
 Sample Copy)
     Sl         Nature of               Name of NLD/ILD     Period of          Copy of the
      No         Contract                Provider            contract           contract
                                                                                submitted to
                                                                                Licensor
9. Status of fulfillment of Roll –Out obligations as per License conditions.
 1) 10% MRO 2) 50 % MRO (Attach Certificate)
10. MNP process & its Grievance redressed Mechanism. (Enclose Flowchart
 pattern).
11.     Postpaid & Prepaid Tariff. (Attach The Available Plans).
12.     Postpaid & Prepaid Schemes. (Attach The Available Schemes).
13.     Methodology for Registration of Demand for the telephone, mobile & broadband
        connections & provisions. (Attach the Methods in Flow Chart & Attach the
        sample CAF alongwith POA/POI).
14.     Samples of itemized bills provided to customers (Bills in adequate details giving,
        Billing Cycle, Plan and Billing procedure.) (Attach the Sample)
15.        Disaster Management – Preparedness Plan as per SoP-2020 including the
        following:
      i.      Compliance on the status ICR Roaming (copies of agreements to be
            submitted
     ii.      Compliance on the status of PCR implementation
     iii.     Compliance on the status of CAP implementation
     iv.      Drills conducted during the past one year
              Signature _________________________________                                   Page 16 of 19
                                                              Inspection Schedule of Licensee (UL- AS)
E.   Financial
1.    Equity details as on Latest. (FINANCIAL STAKEHOLDERS), (AS PER FORMAT).
     S No.     Name of promoters             Indian/Foreign     % of equity held       Net worth
2.   Composite Foreign equity of the Licensee Company as per FDI Notification.
     Table from other to be added
3.   Copy of Statement of Revenue and License Fee for the previous 8 quarters.
     (ATTACH THE HARD & SOFT COPIES OF SAME)
4.   Copy of Audit report on statement of Revenue and License Fee. (ATTACH HARD
     & SOFT COPIES)
5.   Copy of Annual Financial Statement. (PROFIT & LOSS, CASH FLOW &
     BALANCE SHEET, ATTACH HARD & SOFT COPIES OF SAME).
Representative of Licensee Company
Signature:
Name:
Designation:
        Signature _________________________________                                        Page 17 of 19
                                                           Inspection Schedule of Licensee (UL- AS)
                                              Annexure-I
                               TRAFFIC REPORT (Parameters)
The essential parameters required in traffic reports (MSC wise) are:
1. Trunk Group Name
2. POI operator
3. Busy Hour
4. Incoming traffic (in Er)
5. Outgoing traffic (in Er)
6. Incoming Call completion ratio
(IC CCR= Incoming successful calls / Total Incoming Calls)
7. Incoming Answer to Seizure Ratio
(IC ASR = Incoming calls Answered / Total Incoming calls seizure)
8. Outgoing Call completion ratio
(OG CCR= Outgoing successful calls / Total Outgoing Calls)
9. Outgoing Answer to Seizure Ratio
(OG ASR = Outgoing calls Answered successfully / Total Outgoing calls seizure)
10. Total Incoming calls
11. Total Incoming seizure
12. Total Incoming calls Answered
13. Total Outgoing calls
14. Total Outgoing seizure
15. Total Outgoing calls Answered
16. % congestion
17. Total traffic handled
       Signature _________________________________                                      Page 18 of 19
                                                              Inspection Schedule of Licensee (UL- AS)
                                             Annexure ‘II’
                                      Format for Compliance
 Subject: Compliance to Amendments in Telecom Licenses issued by Department
         of Telecommunications for procurement of Telecommunication
         Equipment from Trusted Sources – reg.
This is to certify that we do hereby comply with the norms to be followed by licensee
in license condition no.
    i) Clause 39.7.1of Unified License OR
   ii) Clause 41.6A(iii) (a) of UAS License OR
   iii) Clause 23.7 A(x) of NLD or 23.7A(x) of ILD License OR
   iv) Clause 1.10.12 of ISP License Granted Under Guidelines dated 08.03.2002
         OR
   v) Clause 34.29 of ISP License Granted Under Guidelines dated 24.08.2007 OR
   vi) 38.7.1 of UL(VNO) (whichever is applicable) issued by DoT vide license
         amendment          dated      10.03.2021       &   15.03.2021    for   procurement         of
         Telecommunication equipment.
                                                      (Signature of Authorized Signatory)
                                                      Name:
                                                      Designation:
                                                      Date:
                                                      Email Id:
                                                      M. No:
                                                  Name of Licensee:
                                                  Type of License held:
                                              UASL/UL/UL(VNO)/NLD/ILD/ISP
                                                  License No.
                                                  Service Area:
        Signature _________________________________                                        Page 19 of 19