.SS Domain Application - National Communication Authority (NCA)

.SS Domain Application Form

Institution Name: *

Street Address *

City/Town *

Country *

Applicant is a(n): (Tick as applicable) *IndividualCorporationUnincorporated Association/PartnershipNGO

Nature of Application: (Tick as applicable) *New applicationModification an existing licenseRenewal of an existing license

Telephone: *

Email Address *

Website

Name of Representative: *

Title:

Department:

When issued, license Owner will be: *

Street Address *

City/Town *

State *

Country *

Registration No: *

TIN: *

Email Address *

Website

Billing name: *

Name and contacts of person in charge of technical issues: *