Application for Radio License
NO.
| Name of applicant | Status |
| Nationality | Address |
License required by
| PO Box | Telephone |
Reason for requesting license
Requested duration of license
Particulars of Radio Communication Equipment
| Manufacturer | Model | Power | Serial No. | Quantity |
| Location of Radio Station | Type of Station | |||
|---|---|---|---|---|
| Region | Province | District | Locality | Base, Mobile, Other |
| Communication circuit | Air Distance (km) | Frequency | Emission | Type of Antenna | Operating Time |
| Place | Date | Signature & Stamp |
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