Malaysian Communications and Multimedia Malaysia

MCMC Tower 1, Jalan Impact, Cyber 6, 63000 Cyberjaya, Selangor Darul Ehsan
Tel: 03-8688 8000 Fax: 03-8688 1000 http://www.mcmc.gov.my

APPLICATION FOR THE REGISTRATION OF ACCESS AGREEMENTS

UNDER SECTION 90-93 AND 150 OF THE
COMMUNICATIONS AND MULTIMEDIA ACT 1998

1. PARTIES TO THE ACCESS AGREEMENT

Organisation Name
Company No
Address of
Registered Office
Postcode
Address of Principle
Place of
Business Postcode
Telephone No Fax No
Organisation Name
Company No
Address of
Registered Office
Postcode
Address of Principle
Place of
Business Postcode
Telephone No Fax No
Organisation Name
Company No
Address of
Registered Office
Postcode
Address of Principle
Place of
Business Postcode
Telephone No Fax No
Organisation Name
Company No
Address of
Registered Office
Postcode
Address of Principle
Place of
Business Postcode
Telephone No Fax No

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2. GENERAL DESCRIPTION OF THE MATTER PERTAINING TO THE ACCESS AGREEMENT

3. DATE OF THE ACCESS AGREEMENT

DD/MM/YY

4. DATE OF EXPIRY OF THE ACCESS AGREEMENT

DD/MM/YY

5. This application is made pursuant to the requirement of section 90 and section 150 (1) of the
Communications and Multimedia Act 1998 (please tick) :

Yes No

6. This Access Agreement is for the provision of listed network facilities and network services as per
section 150 (1) of the Communications and Multimedia Act 1998 (please tick):

Yes No

7. This Access Agreement is for the provision of network facilities and network services in the current
Access List, made pursuant to section 146 of the Communications and Multimedia Act 1998,
whose terms and conditions are based on the current Commission Determination on the
Mandatory Standard on Access and the current Commission Determination on the Mandatory
Standard on Access Pricing (please tick):

Yes No

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 8. The Access Agreement is consistent with (please tick):

(i) The objects of the Communications and Multimedia Act 1998;

(ii) Any relevant instrument under the Communications and Multimedia Act 1998;
(iii) Any relevant provisions of the Communications and Multimedia Act 1998 or its
subsidiary legislation.

Yes No

9. Where there is a registered Access Undertaking (please tick):

(i) The party to the Access Agreement is aware of a registered Access Undertaking lodged
by the other party to the Agreement;
(ii) If the Access Agreement complied with the registered Access Undertaking.

Yes No

GENERAL DESCRIPTION OF THE ACCESS UNDERTAKING REFERED TO ABOVE (if applicable)

Name and contact details of party whose

1 Undertaking is registered

2 Date of Registration of the Undertaking

3 Names and contact details of the parties to whom the

undertaking applies

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10. DECLARATION

We______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
(names of parties to the Access Agreement) hereby declare that the above information is true to the
best of our knowledge and that we have satisfied the requirements as stipulated in the Guideline on
Registration of Access Agreements under Sections 90-93 and 150 of the Communications and
Multimedia Act 1998.

Signature : Company Stamp :

Name :
Designation : Date :

Signature : Company Stamp :

Name :
Designation : Date :

Signature : Company Stamp :

Name :
Designation : Date :

Signature : Company Stamp :

Name :
Designation : Date :

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 REQUIREMENTS FOR APPLYING FOR REGISTRATION OF ACCESS AGREEMENT

1. Parties who wish to apply for registration of an Access Agreement shall abide by the following:

(a) Three (3) certified true copies of the stamped Access Agreement shall be submitted in a sealed envelope
clearly labeled with the words “Application for Registration of Access Agreements” to:

The Chairman
Malaysian Communications and Multimedia Commission
MCMC Tower 1, Jalan Impact,
Cyber 6, 63000 Cyberjaya,
Selangor Darul Ehsan
(Attention: Head of Market Regulation Division)

(b) This Application Form shall be signed by the applicant’s Chief Executive Officer or Chief Operating Officer.

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