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Nee must forward this form along with a copy of the CO Code Part 3 to the NPAC. For a pooling NXX, the new LERG Assignee must forward this form to the PA. Section A: New LERG Assignee: Company Name: Contact Name: Address: City, State, ZIP: Phone: Fax: E-Mail: Service Provider NPAC SOA SPID1 LRN2 - - NPA-NXX - Block(s) NXX/Block(s) Effective Date - - NPAC Activate Block Range3 Yes No 1 The Service Pro.

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