A) OSOBNI PODACI. PERSONAL DATA. PERSÖNLICHE ANGABEN
1. Ime i prezime
Full name
Vorname und Name _______________________________________________________
2. Adresa, broj telefona
Full address and telephone number
Adresse, Telefonnummer ___________________________________________________
3. Broj putovnice
Passport No
Reisepa Nr. _____________________________________________________________
B) TEHNIKI PODACI. TECHNICAL DATA. TECHNISCHE DATEN
1. Tip i serijski broj uredaja
Type and serial number of unit
Typ und Seriennummer des Gertes ____________________________________________
2. Vrsta emisije, vrsta antene
Type of transmission and aerial
Funkart, Antennentyp _____________________________________________________
3. Snaga
Installed power
Lesitung ______________________________________________________________
4. Lokacija odailjaa (ili vie lokacija ako je u pokretu)
Transmitter location (or locations, if mobile)
Lokation des Senders (oder mehrere Lokationene, wenn er
mobil ist) _____________________________________________________________
5. Podruje frekvencije koje koristi (od-do)
Used frequency range (from-to)
Frequenzbereich (von-bis) _________________________________________________
6. Vrijeme koritenja (dozvola se trai za period od-do)
Period of use (licence requested for the period from-to)
Bertriebfrist (die Erlaubnis wird fr die Frist von-bis
beantragt) ____________________________________________________________
7. Da li se radi o fiksnoj, pokretnoj
(mobilnoj) ili prenosnoj postaji?
Is it a stationary, mobile or
portable station?
Ist es ein Stationres, Mobiles
oder Portables Funkgert? _________________________________________________
____________________________________________________________________
Mjesto, datum I Potpis podnosioca
Place, date and Signature of applicant
In, den und Unterschrift des Antragstellers