APPLICATION FOR AMATEUR RADIO LICENSE
Mauritius
SURNAME ________________________________________________________________
FIRST NAME ______________________________________________________________
DATE OF BIRTH ___________________________________________________________
OCCUPATION _____________________________________________________________
NATIONALITY ____________________________________________________________
HOME ADDRESS __________________________________________________________
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ADDRESS IN MAURITIUS ___________________________________________________
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DATE OF OPERATION ______________________________________________________
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ENCLOSED DOCUMENTS:
A) PHOTOCOPY OF LICENSE
B) PHOTOCOPY OF PASSPORT
2 PHOTOGRAPHS
I CERTIFY THAT ALL THE ABOVE INFORMATION CONTAINED HEREIN IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I WILL OBSERVE ALL INTERNATIONAL AND NATIONAL RADIO REGULATIONS.
SIGNED ________________________________________
DATE _________________________________________