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The plus symbol on a country code indicates "insert your international access prefix here."

The most commonly used international access prefix is 00, but there are many countries that use other prefixes. For example, North America (USA, Canada, etc.) uses 011, Japan uses 010, Australia uses 0011, and Russia uses 8~10, and there are several others. On a GSM mobile phone (but not necessarily other flavors of mobile phone), you can enter a number in full international format, starting with the plus symbol, and let the mobile network automatically substitute the appropriate prefix.

The correct international format for a telephone number is +Country City Number, where +Country is the ITU country code (e.g., +1 for North America, +44 for the UK, +233 for Ghana), "City" represents the city code, and "Number" represents the subscriber number. In most (but not all) cases, you must drop the trunk prefix 0 from the domestic area code to get the city code: for example, Munich is in German area code 089, but its city code is +49 89. Use only the single plus symbol, digits, and blank spaces; no other punctuation should be included in an international-format telephone number.

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