Application for Telecommunication Line Terminal Equipment (Tlte) to Be Licensed for Use
INDEPENDENT COMMUNICATIONS AUTHORITY OF SOUTH AFRICA (ICASA)
APPLICATION FOR TELECOMMUNICATION LINE TERMINAL EQUIPMENT (TLTE) TO BE LICENSED FOR USE ON THE SOUTH AFRICAN PUBLIC SWITCHED TELEPHONE NETWORK (PSTN)
1. Name and address of South African registered company in whose name the licence must be issued:Name of company:
Company Registration Number:
Physical Address:Postal address:
Code:
Telephone No.: / Fax No.:
Cell No.: / Contact Person:
Email address:
2. Name and address of any other person or organisation acting on behalf of the licensee:
Name:
Address:
Code:
Telephone No.: / Fax No.:
Cell No.: / Contact Person:
Email address:
3. Name and address of original equipment manufacturer:
Name:
Address:
Telephone No.: / Fax No.:
Contact Person:
Email address:
4. Equipment description:
4.1 Type of equipment:
4.2 Original Equipment details:
4.2.1 Brandname:
4.2.2 Model:
4.3 Details of equipment marketed in South Africa:
4.3.1 Brandname:
4.3.2 Model:
5. Modifications (if any) to rectify non compliance. (Attach additional sheets if required)
6. For ICASA inspections, please indicate where modifications (if applicable) and maintenance work on this equipment will be carried out.
Company:
Address:
Telephone No: / Fax No:
Contact Person:
Email address:
7. Person(s) to whom technical enquiries may be directed.
i. Name: / Telephone No:
ii. Name: / Telephone No:
Email address:
8. Indicate with “x” which facilities are provided by the equipment:
Manual dialling
Automatic/repertory dialling
Remote control
Manual answering
Automatic answering
Audible ring indication
Recording from line, or line monitoring
Loudspeaker output from line
Speech transmission to line
Handsfree loudspeaking
Facsimile transmission/reception
Handset
Headset
Signalling between radio receiving & transmitting equip. over the network
Conference facilities
ISDN:
BRAIF
PRAIF
Cordless Telephony:
46 MHz - 49 MHz
CT2
DECT
ITU-T recommended Modem
Lightning /Surge protection
Other:
9. Indicate whether the equipment is intended for use on:
PSTN exchange linePABX extension line
Leased-line
10. The following documentation MUST accompany this questionnaire upon application:
10.1 Two identifying photographs of at least postcard size of the equipment to be licensed. Colour photographs are preferred. (Photocopies are not acceptable.)
10.2 A functional description of the equipment, at least at block diagram level.
10.3 Operating instructions.
10.4 The original or a certified copy of the test report, issued by an accredited communication test facility.
10.5 Detailed circuit diagrams, approved and stamped by the test facility and highlighting any modifications which have been incorporated.
10.6 The originals or certified copies of the test report to the relevant EMC/EMI standard issued by an accredited test facility.
10.7 The original or a certified copy of the test report to the relevant Safety standard, issued by an accredited test facility.
10.8 A sketch or drawing showing the methods of connection to the telephone line and the interface to the telephone line.
10.9 The prescribed application and licensing fees. Cheques shall be payable to ICASA.
10.10 A letter of undertaking from the original equipment manufacturer (OEM), stating that he accepts responsibility for incorporating any modifications, required in terms of the South African specifications, if these cannot be done by the local supplier.
10.11 A certified copy of the supply agreement between the supplier and the OEM reflecting the terms and conditions of support to the local supplier in terms of spare parts, training and software.
NOTE: Inadequate support documentation, the absence of the application or licensing fee and/or an incomplete application form will result in the application being not processed.
11. Please indicate the number of labels to be issued with the licence:
TYPE / QUANTITYSMALL LABELS (25 X 12 mm)
LARGE LABELS (50 X 25 mm)
Note: The cost of labels is additional to the application and licence fees.
12. Application fees:
12.1 The correct application and licensing fee must be ascertained and submitted together with the completed application form. Cheques must be made payable to ICASA.
12.2 Application fees are reviewed periodically and published in the Government Gazette. A separate application fee is payable in respect of every application submitted.
13. Submission of forms:
13.1 Postal address:
The completed application form and support documentation must be submitted to:
The Senior Manager
Equipment and Supplier Licensing
Independent Communications Authority of South Africa (ICASA)
Private Bag X10002
SANDTON
2146
South Africa
13.2 Physical address:
Completed application documentation may also be delivered by hand to:
Pinmill Farm
Block A
164 Katherine Street
SANDTON
2146
14. UNDERTAKING BY APPLICANT:
14.1 I/We agree that access to the premises specified in Paragraph 6 hereof will be given at all reasonable times to ICASA inspector(s) for the purpose of inspection and/or testing of equipment, in connection with licensing.
14.2 I/We submit, together with this application form, the prescribed application and licensing fees.
14.3 I/We submit, together with this application form, complete technical documentation as stipulated in Paragraph 10 hereof.
14.4 I/We undertake to assist ICASA staff at my/our expense, in all aspects reasonably required for testing, inspection and/or evaluation purposes.
14.5 I/We undertake that all equipment supplied, subsequent to the issue of the licence applied for, shall contain all modifications necessary in order to satisfy ICASA’s requirements, as prescribed.
14.6 I/We accept that the licensing of the aforementioned system shall be subject to the provisions of the Telecommunications Act, 1996 (Act No. 103 of 1996) as amended, and the conditions imposed by ICASA.
I/We accept liability for the charges prescribed.
Name of applicant: / (Please Print)Signature:
Capacity:
Name of Company:
Address:
Date:
4
TLTE application form