Confirmation of NXX-X Block Activation (Required)

By signing below, I certify that the thousand block(s) (NXX-X(s)) specified in Section 1 below is in service and is being used for the purpose specified in the original application.

_________________________________________ _________________________ Representative of Pooling Administrator (Print) Signature

_________________________________________ ____________

Title Date

1. NPA-NXX-X block(s): ________________________________________________

2. Applicant’s Switch Identification (Switching Entity / POI)12 : __________________

3. Dates:

Date of Application: ___________

Effective Date: ___________