STATE OF NEW HAMPSHIRE
Exchange Eligibility Report
Applicable to All Telephone Utilities Expanding Into New Exchanges
|1. General Information |
|Legal Name | |
|Federal Employer Identification Number | - |
|(FEIN) | |
|Telephone Utility Identification Number if | |
|one has been assigned | |
|Trade Name(s) d/b/a | |
|in New Hampshire | |
| | |
|Complete Mailing | |
|Address | |
| | |
| | |
| | |
|Phone Number | - - |
|E-mail Address | |
|Website | |
| |
|2.Definitions |
|A telephone utility must complete this form when first establishing a local nexus in a particular exchange area, thereby entitling it to number assignments. |
|Local Nexus |The presence of physically located customers, as shown by: |
| |1. Collocation with the ILEC in the exchange. |
| |2. Provisioning of service via local loops owned by the utility. |
| |3. Provisioning of service via Enhanced Extended Links (EELs). |
|Customer |For the purposes of this report, a customer is defined as a billing entity. Count one customer for each separate |
| |bill rendered in a billing cycle. |
|Instructions |
|For each exchange area in which your company has become eligible to provide service since filing an earlier Exchange Eligibility Report, describe your |
|operations showing how you meet the local nexus test. |
|3. Signature |
| |
|I certify that the information on the attached report is true and correct to the best of my knowledge and belief subject to the penalty for making unsworn false|
|statements under RSA 641:3. |
| |
|Authorized | |Title | |
|Representative Signature | | | |
| |
|Printed Name | |Date | |
|4. Report Statistics |
|a. Exchange Name |b. NXX-(n) |c. Collocation with |Other Provisioning Type |g. Customer Information |
| | |ILEC (yes/no: if |(State Number of Customers) |Name, Address and Telephone Number of a |
| | |Yes, skip d-g) | |Representative Customer in this Exchange |
d. Owned Loop: Copper Coaxe. Owned Loop: Fiberf. EELs
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