The Hashemite Kingdom of Jordan Telecommunications Regulatory Commission
ﻫﻴﺌــﺔ ﺘﻨﻅﻴــﻡ ﻗﻁــﺎﻉ ﺍﻻﺘﺼــﺎﻻﺕ
ﺍﻟﻤﻤﻠﻜﺔ ﺍﻻﺭﺩﻨﻴــﺔ ﺍﻟﻬﺎﺸﻤﻴــﺔ
(Form# STA1-4, rev.1)
Telecom Terminal Equipment Sample Recovery Form
Date: ………………………………… Recipient Name: …………………………………...………………………………….………….. Representative of Company/ Custom ………………………………………………………. I have received the samples mentioned below which previously submitted to the Telecommunication regulatory Commission for testing purposes according to the commission in notice # …………………. Date ……………..
Equipment Name
1 2 3 4 5 6 7 8 9
Brand
Model
Quantity
Country of Origin
Recipient Identity
Signature
1/9/2004
1/1