15th June, 2012 Statutory Instruments 243 Form II (Regulation 6(2)) THE ZAMBIA INFORMATION AND COMMUNICATIONS TECHNOLOGY AUTHORITY The Information and Communication Technologies Act, 2009 (Act No. 15 of 2009) The Information and Communication Technologies (Universal Access) Regulations, 2010 LICENCE No..…………………. DESIGNEE REF........................... UNIVERSAL ACCESS PROVIDER DESIGNATION (Section 73 of the Information and Communication Technologies Act, No. 15 of 2009) Designee’s name ……………………….……………………………………..……………....... Address…………………………………………...……………………………….……....…….. Type of universal access service: (a).............................................................................…......................................................... (b)......................................................................................................................................... (c).................................................................................…………………………….................................. (d)...............................................................................……………........................................ This designation is granted for a period of ………..…… commencing on the ……………….. day of ………………………….……………… 20………………..…. The conditions of the designation are as shown in the Annexures attached hereto. Issued at …………………… this ………………… day of …………..……………................ ….…………..…………………………………… Director - General ENDORSEMENT OF DESIGNATION This designation has this ……………………………. day of ………………….., …………… ……………………………………….. been registered in the Register. ..……..………….………………………… Director-General