OBRAZAC ZAHTJEVA ZA IZDAVANJE RADIO DOZVOLE
APPLICATION FORM FOR RADIO LICENCE
ANTRAGSFORMULAR FUER AUSSTELLUNG EINER FUNKERLAUBNIS



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

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