1a. Short Code Application Form

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Bangladesh Telecommunication Regulatory Commission

IEB Bhaban (5th, 6th & 7th Floor), Ramna, Dhaka-1000.

Short Code Application Form

Name
of

Applicant

Registered business name (if different)


....................
...
Postal Address
....................
...
....................
...
....................
...
Registered office address (if different)
....................
...
....................
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Contact Person
Name
....................
...
Telephone number
.
.
Facsimile number
....................
...

E-mail address
....................
...
Description of the intended use of code (including qualitative and quantitative
characteristics of the service)
....................
...
....................
...
....................
...
....................
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Estimated starting date of service
....................
...
....................
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Network connectivity for the proposed service in detail
....................
...
....................
...
....................
...

Applicant will apply in their respective letter pad along with this form and
following documents:
1.
2.
3.

Attested copy of current Trade license


Attested copy of current income Tax clearance certificate.
Attested copy of certificate of Incorporation for registered company.
Declaration:

1. I/We certify that the information/documents provided in this application


are true and correct and I/We undertake to comply with the terms and
conditions stated in short code allocation procedure.
2. I/We understand that if at any time any information furnished for
obtaining short code is found incorrect then the code 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
of
authorized
..

person

Name
................
Position
..
Date
Place.........

&

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