REPUBLIC OF NAMIBIA

NAMIBIAN COMMUNICATIONS COMMISSION

APPLICATION FOR AN AMATEUR RADIO GUEST LICENCE

(The form must be completed in capital letters)

1. SURNAME (MR/MRS/MISS)

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2. FIRST NAMES IN FULL

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3. PLACE (TOWN AND COUNTRY) AND DATE OF BIRTH

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4. CONTACT ADDRESS IN NAMIBIA

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5. CLASS AND CALL SIGN OF LICENCE HELD

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6. CERTIFIED PHOTO COPY OF VALID AMATEUR RADIO LICENCE MUST ACCOMPANY THIS APPLICATION FORM

7. PERIOD OF VISIT TO NAMIBIA (STATE DATES)

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8. DETAILS OF ITINERARY

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9. PLEASE RETURN APPLICATION FORM AT LEAST FIVE (5) WEEKS BEFORE LICENCE REQUIRED TO :

NAMIBIAN COMMUNICATIONS COMMISSION, PRIVATE BAG 13309, WINDHOEK

10. LICENCE FEE : N$50,00 WITH APPLICATION.

DATE _____________________________________________________________

SIGNATURE _________________________________________________________

 


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