Application Form

This document pretains to ARC-MOD-20050505-00006 for Modification on a Accounting Rate Change filing.

Approved by OMB 3060-0454

FEDERAL COMMUNICATIONS COMMISSION APPLICATION FOR AN ACCOUNTING RATE CHANGE FOR OFFICIAL USE ONLY

APPLICANT INFORMATION

Enter a description of this application to identify it on the main menu:

CAMBODIA APPLICATION FOR ACCOUNTING RATE CHANGE

1. Applicant Name: Concert Global Network Services Limited Phone Number: 908-532-1911 DBA Name: Fax Number: 908-532-1281 Street: One AT&T Way E-Mail: [email protected] City: Bedminster State: NJ Country: USA Zipcode: 07921 - Attention: Mr Steven A Sillett

2. Contact Name: Steven Sillett Phone Number: 908-532-1911 Company: AT&T Fax Number: 908-532-1281 Street: One AT&T Way E-Mail: [email protected] City: Bedminster State: NJ Country: USA Zipcode: 07921 - Attention: Relationship:

3. Application Type: Modification of Existing Accounting Rate Petition for Declaratory Ruling

4. U.S. Carrier: Concert Global Network Servies Limited 5. Foreign Carrier: Ministry of Posts & Telecommunications, Kingdom of Cambodia (MPT-C) 6. Foreign Point Being Served: Cambodia

4. U.S. Carrier: Concert Global Network Servies Limited 5. Foreign Carrier: Ministry of Posts & Telecommunications, Kingdom of Cambodia (MPT-C) 6. Foreign Point Being Served: Cambodia

4. U.S. Carrier: Concert Global Network Servies Limited 5. Foreign Carrier: Ministry of Posts & Telecommunications, Kingdom of Cambodia (MPT-C) 6. Foreign Point Being Served: Cambodia

7. 1: Cambodia 2: 3:

SERVICE INFORMATION S1. U.S. Carrier: Concert Global Network Servies Limited S2. Foreign Carrier: Ministry of Posts & Telecommunications, Kingdom of Cambodia (MPT-C) S3. Foreign Point Being Served: Cambodia

S4. Service: IMTS

S5. Current Rate: 0.70SDR S6. New Rate: 0.60SDR S7. Surcharge: NONE

S8. Effective Date: 07/01/2002 S9. Expire Date: 12/31/2002

S10. [50/50]: Yes No S11. Proportionate Return: Yes No

SERVICE INFORMATION S1. U.S. Carrier: Concert Global Network Servies Limited S2. Foreign Carrier: Ministry of Posts & Telecommunications, Kingdom of Cambodia (MPT-C) S3. Foreign Point Being Served: Cambodia

S4. Service: IMTS

S5. Current Rate: 1.00SDR S6. New Rate: 0.90SDR S7. Surcharge: none

S8. Effective Date: 01/01/2001 S9. Expire Date: 12/31/2001

S10. [50/50]: Yes No S11. Proportionate Return: Yes No

SERVICE INFORMATION S1. U.S. Carrier: Concert Global Network Servies Limited S2. Foreign Carrier: Ministry of Posts & Telecommunications, Kingdom of Cambodia (MPT-C) S3. Foreign Point Being Served: Cambodia

S4. Service: IMTS

S5. Current Rate: 0.90SDR S6. New Rate: 0.70SDR S7. Surcharge: NONE

S8. Effective Date: 01/01/2002 S9. Expire Date: 06/30/2002

S10. [50/50]: Yes No S11. Proportionate Return: Yes No

WILLFUL FALSE STATEMENTS MADE ON THIS FORM ARE PUNISHABLE BY FINE AND / OR IMPRISONMENT (U.S. Code, Title 18, Section 1001), AND/OR REVOCATION OF ANY STATION AUTHORIZATION (U.S. Code, Title 47, Section 312(a)(1)), AND/OR FORFEITURE (U.S. Code, Title 47, Section 503).

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