Details of Applicant Details of Applicant Last name First name Phone Mobile phone Email N° Street / Avenue Local community Delegation Postal code Governorate Information on the base station object of complaint Information on the base station object of complaint N° Street / avenue Local community Delegation Postal code Governorate Installation - Select -YesNo Operation - Select -YesNo With Approval - Select -YesNo Operator - Select -Tunisie TelecomOoredooOrangeNo information Site Code Description of the base station environment subject to complaint Description of the base station environment subject to complaint Proximity to sensitive establishments Kindergartens / nurseries School Hospital / Paramedical establishment Retirement home N° Street / Avenue Local community Delegation Postal code Governorate Other observations
