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 _________________________________________