http://www.anacom.pt/template31.jsp?categoryId=217282 1. IDENTIFICATION PARTICULARS Natural persons: Full name Taxpayer number Address for notification Telephone number(s) Fax number(s) Email address Legal persons: Name of company Legal person number Address of company headquarters Address for notification Telephone number(s) Fax number(s) Website Email address Shareholding composition Main shareholders of identification is possible) 1. 2. 3. 4. 5. 6. 7. Main shareholders of identification is possible) 1 2 Name shareholders 1st level1 (where 2nd level2 (where of Share (at least 10% of the share capital) Shareholders subscribing directly the entity’s share capital. Shareholders subscribing directly the direct shareholders of the entity. 1 1. 2. 3. 4. 5. 6. 7. 2. CONTACTS FOR NOTIFICATION PURPOSES Natural persons Contact person Telephone number(s) Fax number(s) Email address(es) Remarks Responsible person in situations of disaster or within the scope of the National Emergency Plan Telephone number(s) Fax number(s) Email address Remarks Legal persons: 1st Contact Person Name Position within the undertaking Telephone number(s) Fax number(s) Email address Remarks Responsible person in situations of disaster or within the scope of the National Emergency Plan Name 2 Position within the undertaking Telephone number(s) Fax number(s) Email address Remarks A) Description of the electronic communications network a) Type(s) of network(s) to be established, operated, controlled or made available, such as: Provision (publicly available network) Wholesale Establishment Operation Control provision 3 Leased lines Retail provision4 Leased Others Others lines 1. Fixed network 1.1. Fixed telephone network 1.2. Other fixed networks 2. Mobile network 2.1. Mobile telephone network 2.2. Other mobile networks 3. Satellite network 4. Radiocommunications network between fixed points, including the fixed wireless access network (FWA) 5. Electric network, where used for signal transmission purposes 6. Networks used for the transmission and 3 Wholesale provision: provision aimed at other undertakings that provide electronic communications networks and services. 4 Retail provision: provision aimed at end-users, that is, both at residential users (consumers) and at business/professional purpose users who do not provide publicly available electronic communications networks and services . 3 distribution of radio and television programmes to the public 7. Cable distribution network 8. Wireless-lan network 9. Other networks 3 Tick with an X the network(s) to be provided. Other networks (to be described in detail by the interested party): ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ b) Description of the nature, characteristics and functioning of the network(s), including the following information: Geographic coverage scope; Technology (technologies) to be used; Short description of the network architecture and diagram that facilitates the description; Short description of the plans concerning the information system and network management; Short description of the measures to be adopted in order to ensure the network security; Indication whether the network is owned or belongs to another entity, fully or in part; Indication whether the network installation requires the occupation of public domain or of private property; Indication whether the network supports the provision of radio and television broadcasting services. c) The network provision involves the use of radio spectrum: Yes, in the frequency band ______________________________. No. d) The network provision involves the use of numbering facilities: Yes. 4 No. e) Indication of the date set for the beginning of the network provision. In case the purpose of the network is to support services to be made available to the end-user by the undertaking itself or to provide such services to other operators/ providers for the establishment of the network or the support of their services, the date for the beginning of each of these activities must be discriminated, where such activities do not commence at the same time. 5 B) Description of the electronic communications service The description of the service must comprise the following information: a) Indication of the service(s) to be provided, such as: Service of access to the public telephone network at a fixed location5; Leased lines service (retail provision)6; Telephone service at a fixed location; Mobile telephone service; Resale service of the telephone voice traffic; Resale service of short data traffic (SMS); Public payphone service; Virtual phone card service; Voice transport service in closed user groups;; Data transmission service: Internet access service; Voice over Internet service; Other data services. Virtual private networks service (VPN); Service via satellite; Line resale service; Other services (to be described in detail by the interested party): ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Tick with an X the service(s) to be provided. 5 This service is provided by entities holding the retail provision of the fixed telephone network (according to the table, under heading A, which includes the list of the electronic communications networks). 6 This service is provided by entities holding the retail provision of leased lines (according to the table, under heading A, which includes the list of the electronic communications networks). 6 b) Target market: Wholesale service (provision aimed at other undertakings that provide electronic communications networks and services); Retail service (provision aimed at end-users, that is, both at residential users (consumers) and at business/professional purpose users who do not provide publicly available electronic communications networks and services). c) Description of the service’s nature, characteristics, functioning and respective geographical scope; d) Diagram that facilitates the description of the service(s), including the indication of the technology (technologies) to be used; e) Indication of the support network for each service to be made available (support, fully or in part, over an owned network or a network belonging to another entity); f) Date set for the beginning of the provision of service(s); g) The service provision involves the use of radio spectrum: Yes, in the frequency band ________________________. No. h) The service provision involves the use of numbering facilities: Yes. No. 7
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