Last Name:                               First name:

Birth date:                              Nationality:

Home Address:

The applicant possesses this license:

Number:             Class:               Callsign:

Proposal for a Liechtenstein License:

From date:                               To date:

Location of operation:

Application Fee:

Send 35 Swiss Francs with the application to:

Dienstelle Fur Post-und Fernmeldewesen
Vaduz, Liechtenstein

Enclose a copy of current valid Amateur Radio License

Place, Date, Signature:

Remarks: