Telephone: Fax: (679) 300 766

Ministry of Information, Broadcasting and Telecommunications DEPARTMENT OF COMMUNICATIONS P.O. Box 2264, Government Buildings Suva, FIJI

Ref No: Date:

RADIO AMATEUR STATION - APPLICATION FORM

1. NAME: .................................................................. FEMALE / MALE: ..........................

2. ADDRESS: ........................................................................................................................

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3. INTENDED LOCATION OF OPERATION

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4. PARTICULARS OF AMATEUR EQUIPMENT

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5. PLEASE ATTACH
- PASSPORT SIZE PHOTOGRAPH
- PHOTOCOPY OF RADIO AMATEUR CERTIFICATE

USD 13 enclosed

Signature: .....................................................

Date: ............................................................

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