Registration Form for a Single Issuer Identifier Number for the International Telecommunication

Registration Form for a Single Issuer Identifier Number for the International Telecommunication

<p>Registration form for a single Issuer Identifier Number for the international telecommunication charge card system issued by the Telecommunications Administrations</p><p>To be returned with registration fee 1) to: INTERNATIONAL TELECOMMUNICATION UNION TELECOMMUNICATION STANDARDIZATION BUREAU PLACE DES NATIONS CH - 1211 GENEVE 20 SWITZERLAND FAX : +41 22 730 5853; E-mail : tsbtson@itu.int This registration is submitted in accordance with International Standard ISO 7812. Identification cards - Numbering system and registration procedure for issuer identifiers.</p><p>A. TO BE COMPLETED BY APPLICANT (Card Issuer) Name or organization</p><p>Address to be registered (maximum two lines, 30 characters per line)</p><p>Principal contact in organization</p><p>Telephone number Telefax number E-mail : + + Address for correspondence</p><p>Effective date of usage or cancellation</p><p>Date In signing this form the applicant accepts that further IINs will not be assigned to identify products, services, technologies or geographic locations.</p><p>Signature:</p><p>B. TO BE COMPLETED AND APPROVED BY THE TELECOMMUNICATIONS ADMINISTRATION2) OR DULY AUTHORIZED COORDINATING ORGANIZATION a) Action Requested (check appropriate box) Registration  or Cancellation  b) Major industry identifier (MII) : 89 c) Country code (CC) : ______(according to the List, Complement to ITU-T Recommendation E.164) d) Issuer identifier number : ______(according to ITU-T Recommendation E.118) Name of approving organization</p><p>Date Signature</p><p>C. TO BE COMPLETED BY ITU (CENTRAL REGISTRATION AUTHORITY) Issuer Identification Number registered or cancelled Date : 8 9 ______</p><p>METHOD OF PAYMENT (Please specify the form of payment used) · Switzerland : to the ITU postal cheque account, Geneva 12-50-3; · All other countries: – by international postal order, or – by bank transfer to UBS SA, Geneva (Switzerland), ITU Account No. IBAN CH96 00240 240-C8765565.0 Swift Number : UBSWCHZH80A (payment may also be effected by a cheque made out in another currency freely convertible into Swiss francs, provided that the cheque, when cashed and converted, will cover the amount of the registration fee in Swiss francs) · By credit card EUROCARD-MASTERCARD  VISA  AMERICAN EXPRESS  Credit card number :______Valid date : ______Holder's name : ______Signature : ______(this form must be signed if you pay by credit card); Please note: letters of credit are not accepted ______1) the fee is currently 80 Swiss francs 2) and/or recognized operating agency (ROA)</p><p>Annex to ITU OB 883-E – 2 –</p>

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