Bangladesh Telecommunication Regulatory Commission

IEB Bhaban, Ramna, Dhaka-1000

Application Form for Internet Protocol Telephony Service Provider

(IPTSP) License
A. Applicant Profile:

1. Name of Applicant

2. Registered Office Address

3. Telephone & Mobile

4. Fax

5. E-mail

6. Website

7. Name of Authorized
Signatory and Contact
Person

8. Type of IPTSP License [] Nationwide Or

Applied for
[] Divisional
(Tick Appropriate)

Division Name-------------------------------------.

B. Details of Existing ISP License:

1. ISP License No.

2. Category of the ISP [] Nationwide or [] Divisional:

License
Division Name:................................

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3. Duration License Date
of Existing ISP Including
Expiry

4. Coverage Area Total Coverage Area (in Coverage Area (District Name
Square Kilometer) only)

Nationwide :

Divisional:

Division Name
..................................................

.................................................

5. Coverage Out of Area Total coverage area (in Square Coverage Area (Area Name
In Rural Area of Total
Kilometer) only)
Coverage
Nationwide :
Divisional:

Division Name
..................................................

.................................................

6. Date of Commencement of
the Service

7. Number of Existing Individual Corporate

Subscriber
Dial-up: Name of Corporate Clients with
Subscriber Number:

Broadband:

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 8. Name of School, College,
University Connected by
the ISP

9. Average Minimum Growth Individual: Corporate:

Rate of Subscribers for per
year (If Applicable)

10. No. of POP Including

Location

11. Other License Awarded by

the Commission to the
Licensee

12. Wireless Network Number of BTS / POP : Frequency

13. Wired Network Length of Laid Cable

Optical Fiber : UTP :

DSL : STP :

ADSL : Other :

14. Bandwidth Details for Last Total Allocation: Total utilization:

Years
IIG:....................................... IPLC.........................................
VSAT:.................................

Provider Name:
IIG:

……………………………………………………………………
……......................................................................................
IPLC:
................................................................................................................
...........................................................................................................
..............................................................................................................
........................................................................................................

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 VSAT:
..............................................................................................................

........................................................................................................

Uplink Allocation

IIG:.................................IPLC:....................................

VSAT:............................................

Medium for Uplink Allocation:

IIG:........................IPLC:............................................

VSAT:..........................................................

Downlink Allocation

IIG:.........................................IPLC:.....................................
VSAT:............................................

Medium for Downlink Allocation:

IIG:.........................................IPLC:...................................

VSAT:............................................

15. Backup Description:

Number of VSAT (If Applicable):

Uplink Allocation Downlink Allocation

Uplink Frequency: Downlink Frequency:

16. Per Subscriber Average Individual : Corporate:

Bandwidth

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C. Business Activities:

Item Attached Not Attached Remarks:

1. Current Organogram

2. Proposed Future
Organogram

3. Present Business Activities

4. Rollout Plan For Next Five

Years

5. Percentage (%) of Local Local: Foreign:

Investment and/or Foreign
Investment

6. No of Total Employees

7. No. of Total IT Specialist

8. Details of Directors and

Shareholders

9. Present Value of Total

Investment

10. Gross Revenue Earned in

Last Year (If Applicable)

11. VAT and TAX Clearance

Certificate Last Year

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 Item Attached Not Attached Remarks:
12. Proposed Tariff and
Charges for IP Telephony
Service

13. Proposed Connectivity with

ICX for IP Telephony
Voice only

D. Following Documents are also to be Duly Certified and to be attached with

the Application Form:
Serial Item Attached Not Attached Remarks

1. Application in a Letter Head Pad

2. Relevant Fees in the Form of Pay

Order/Bank Draft

3. Latest Income Tax Clearance

Certificate

4. Certificate of Incorporation,
MOA, AOA, Form-XII, Schedule-X
(If Applicable )

5. Authorization to the Authorized

Signatory (Resolution of The Board of
Directors/Power of Attorney duly
Notarized )

6. Bank Solvency Certificate

7. Agreement with the Bandwidth

Provider
8. Undertaking on Non Judicial Stamp of
TK. 300/- Sworn Before the Notary
Public of Bangladesh Regarding Not
to Bypass IGW/ ICX and Not to Use
any Kind of VSAT for Voice Traffic.

9. Copy of existing ISP and other

License(s) Issued by the Commission
10. Copy of Agreement with Foreign
Partners/Investors. (If Applicable)

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 Serial Item Attached Not Attached Remarks

11. Certificate from Bangladesh Bank

Regarding Remittance to the Foreign
Company (If Authorized VSAT is
Used)

Statement of Payment for the Preceding

Year Made to the Satellite Company
12.
Through the Local Bank Transaction
for VSAT ( If Applicable )
13. Notarized Affidavit (in Tk. 200/- non-
judicial stamp)

14. Updated Trade License

15. CV and NID of Proprietor/Shareholder

16. Vat Registration Certificate

E. Declaration:

1. Has any Application for License of the Applicant/any Share Holder/Partner ISP
been rejected before? [] Yes [] No

If yes, please provide date of application and reasons for rejection:

2. Do the Applicant/any Share Holder/Partner hold any other Operator Licenses

from the Commission? [] Yes [] No
If yes, please give details

3. Has any other License of the Applicant/any Share Holder/Partner been

rejected before? [] Yes [] No

If yes, please provide date of application and reasons for rejection:

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 4. Do the Applicant/ its owner(s)/ any of its director(s)/ partner(s) were involved in
any illegal call termination using VoIP technology? [] Yes [] No

If yes, please provide the following details:

i. Period of Involvement in illegal VoIP activities: ________________________

ii. Case No (If Applicable):

iii. Administrative fine paid to the Commission (If Applicable):

a. Amount (BDT): _____________________

b. Cheque No./ Bank Draft No.: _____________

iv. Undertaking given to the Commission: [] Yes [] No

5. I/We hereby certify that I/We have carefully read the guidelines/terms and conditions, for
the License and I/We undertake to comply with the terms and conditions therein.

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

Date: Signature
Place: Name of the Applicant/Authorized
Signatory with Seal

Note:

 Application without the submission of complete documents and information will not be
accepted.
 Payment should be made by a Pay order / Demand Draft in favor of Bangladesh
Telecommunication Regulatory Commission (BTRC).
 Application fee is not refundable.
 Application will not be accepted if information’s do not fulfill the relevant terms and conditions
of the Commission issued at various time.
 Any ISP found involved with illegal VoIP business at any time shall not be eligible for any
type of IPTSP License.

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