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Bangladesh Telecommunication Regulatory Commission

IEB Bhaban. Rarnna. Dhaka-l000

I Appli"",ion Fo.r
for In,..n*t S..oi." p.ooid
(For Internet Communication excluding Voice Communication)
ISee Section 36(5) ofthe Bangladesh Telecommunication Regulation Act, 2001]
[Please see the General Information and Guidelines]

! NEW D RENEWAL D ANNUALENDORSEMENT

[Incomplete application will not be entertained and summarily rejected]
A. Applicant Profile

Registered Office Addfess

Telephone & Mobile

Fax
E-mail
I Website

Full Address for

Communication

Telephone & Mobile

Fax
E-mail
I Website

3. Category of License: [ ]CategoryA[ ]CaaegoryB [ ] Category C

Coverage Area : ( Police Station(s) and Metropolitan area,District Name Only )

i!.' Service Profile:(Aliiticabte for.Renewal/Aniiral f,iilbrsement)

L Location of lnstallation(s) :

2. Date ofCommencement of the Servrcc:

Day Monlh

3. Application for the period: To

Day Monh

4. Number & date ofLicense ofrvhich renerval/annual endorscment is sousht for:

License Numbcr: Date:

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 5. Number of Clients,{Jsers oflnternet:

Home : ] | Office/Corporate User : f-l Cyber Cafd: Others : f- l

C, Technical Profite (Appticable Endoisemeit)
t. Wired

z. Bandwidth: Sublease
.A[ocatioLj
Y! - i' 'l Down -
Mediuin:.:,'.
]
1"'' "'
Backup : Ilh - .Down -
Mddit r

D. feioracirBank Draft D;taits

E. Docuii6iits to'bejEn ctosetl:

(i) For a New License (License for providing ISp Category-A,/ Category-B/ Category-C Services):
Usc tick I1l mark in the appropriste box
Serial Items Attached Not Attach€d Remarks
I Application in a Letter Ilead Pad
2 Relevant Fees in the form ofPay Order/ Bank Draft
(Any Scheduled Bank)
l Updated Trade License { Phorocopy)
4 Updated'l'lN Certifi cate (Photocopy)
5 Updated Tax Clearance Certificate (Photocopy if applicable)
6 Latest Bank Solvency Cenificate (Main Cop] )
7 Bank Statemcnr ( Main Copy Lasr 6u Monrhs)
8 Updated House-Rent AgrcemenVOwnership deed (photocopy)
9 Proprietor and/or its partner/share holder shall provide
Undertaking on non judicial stamp of Tk, 300/- sworn before
the notary public of Bangladesh that-

i) Proprietor and,/or its partner/share holder shall comply with

provisions of Bangladesh Telecommunication Regulation
Act,200l and all rules, regulations, directives and notices
issued by the Commission.
ii) Proprietor and,/or its partner/share holder shall not take any
activity over VOIP /WiMAX business and shall not use
VSAT.
iii) Proprietor and/or its partner/share holder are not a Bank
Del'aulter.
iv) Neither the proprietor nor its partner/share holder baned by
section 29, 36(2)(3) of tha Bangladesh Telecommunication
Regulation Act, 2001.
v) Proprictor and/or its partner^hare holder are eligibl€ to get
the License.
vi) Proprietor and./or its partner/share holder shall not provide
Cable TV or IP TV without p or approval of the
Commission and shall not use relevant nehvork/
infrastructure to provide lnternet Servlce.

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 Serial Items Attached Not Remarks
Attached
10 Board Resolution (if applicable)

ll Certifi cate of Incorporation (if applicable)

Partrership agreement/ Memorandum & Articles of
Association with form XII (ifapplicable)
IJ VAT Registration Certifi cate (if applicable)
l4 Agreement with the bandwidth provider
(Nationwide/ Central Zonel Zonal ISp)
t) Proposed TariffChart (on letter head paoJ
l6 Network Diagram (on leuer head pad)
l7 NID or Passport ofProprietor/ Paftner/ Sharetrolder
letrotocopg
l8 2 Copies Passport Size Photo of proprietor/Fartner/ Sharehold

l9 Curriculum vitae/ Bio-data of Proprietor/ partner/ Shareholder

(ii) For Annual Endorsement/ Renewal of the License (License for providing ISP-Cat€gory: A/ Category: Bi/
Cat€gory: C Services):

Use tick [{l mark in the appropriate bor

Serial Items Attached Not Attached Remarks
I Application in a Letter Head Pad
2 Relevant Fees in the form ofPay Order/ Bank Draft
(Any Scheduled Bank)
3 Updated Trade License (Photocopy)
4 Updated Tax Cleaxance Certificate (Photocopy if applicable)

5 Bank Statement (Main Copy Last 6th Monthsj

6 Updated House-Rent Agreement Ownership deed (photocopy)
'1 Board Resolution (if applicable)
8 Pa(nership agreement/ Memorandum & Articles of
Association with form XII (ifapplicabrey
9 Updated VAT Clearance Certificate
l0 Updated Information Regarding Bandwidth Consumption
(Nationwide/Central Zonel Zonal ISP)
ll TariffChart (approved by the Commission)
t2 Coverage map on approved Police station (on letter head pad)

l3 NID or Passport/ Passport Size Photo/ Cuniculum Vitae of

New Partner or Shareholder
t4 Photo Copy ofExisting License/ Renewal Copy
l5 Latest Intemet User/ Client List

l6 Spectum Related Information (if applicable)

c; DeiliiXlion:
1. Has any Application for License oftsp been rejecied before? E yes n No
(ifyes, please give date ofapplication and reasons for rejection)
2. Has any License issued previously to the Applicantany Share Holder/partner been cancelled?

! Yes I
tto lifyes, give details)
3' Do the ApplicanVany Share Holder/Partner hold any other Operator Licenses from the Commission?

I Yes n No lifyes, give derails)

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4. I/we hereby certify that VWe have carefully read the guidelines/terms and conditions, for the license and I/We
undertake to comply with the terms and conditions therein.

5. I/We hereby certify that l/we have carefully read the section 36 ofBangladesh Telecommunication Regulation
Act, 2001 and l/We are not disqualified from obtaining the license.
6. I/We understand that if at any time any information furnished for obtaining the license is found incorrect then
the license ifgranted on the basis of such application shall deemed to be cancelled and shall be liable for action
as per Bangladesh Telecommunication Resulation Act. 2001.

Dat€: Signature
Place: Name of the Prcprietor/ Managing
Partner/ Managing Director/Authorized
Parson with Seal

Information
Interuet Seiiri0eiProimi,,@feca*;_A&6mri.!.r&fl"so.y&fftenqslformation
l. Category A: For each Police Station (p/S) ofDhaka Metropolitan Area.
2. category B: For each Police station (P/s) of Metropolitan Area excluding Dhaka Metropolitan Area.

3. Category C: For each Police Station (p/S) of other than Metropolitan Area.

Note:
The application for annual endorsemcnt ofthe license shall not be entertained beyond 60 (Sixty) days of the expiry
'
ofthe year of license concemed and the licensee shall have to apply before 180 (One hundred and eighty) days of
th€ expiration ofduration of its license or else the license shall be cancelled as per law and penal action shall follow,
if the licensee continues its business thereafter without valid license. The late f€es/fines shall be recoverable under
the Public Demand Recovery Act, 1913 (PDR Act, l9l3) ifthe licensee fails to submit the fees and charqes ro rne
Commission in due time.
. The Fees/Charges are given in circular which is given in the website ($,t!a\,.btrc.qov.bd).
. Application without the submission ofcomplete documents and information will be rejected.
. For Annual Endorsement/ Renewal, please attach a photocopy ofthe existing license.
' Payment should be made by a Pay order/ Demand Draft in favor of Bangladesh T€lecommunication Regulatory
Commission (BTRC).
. All relevant updated documents shall be submitted with the application period.
' All relevant documents should be attested by proprietor and/or its managing partner/ managing director for the
Application period.

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