Tele		Application for a permission to operate
Norwegian		an amateur radio station in Norway Telecommunications Administration

I, the undersigned, hereby apply for a temporary permit to hold and utilize an amateur radio station during the period:

Name

Address in my own country

Object to stay

References in Norway

Member of following radio amateur organization

Profession		Nationality		Date of birth
Place of birth		Call sign		Class		Max Power

Fixed station in Norway

Address

Mobile station in Norway

Vehicle registration number

Place and date

Signature of applicant

The application given above should be sent to the proper licensing Administration in the applicant's country. The Administration concerned is requested to deliver below (under comments on the applicant) an opinion on the actual application. The form should then be forwarded to:

The application should be handed in early enough to arrive at the Norwegian Administration at least one month before the permission is required. Certificate of good conduct issued by the applicant's local police authority is to be enclosed.

Comments on the applicant

Only for use by the Norwegian Administration

Inn dato

Ekspedert dato

Byldig fra-til

Kallesignal