INDIA

APPLICATION FOR THE GRANT OF AN INDIAN AMATEUR W/T LICENCE TO FOREIGN NATIONAL

1. Name of Applicant:
_______________________________________________________________________________

2. List of other names (if any):
_______________________________________________________________________________

3. Date of birth:
_______________________________________________________________________________

4. Place of birth:
_______________________________________________________________________________

5. Father's name and home address:
_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

6. Present occupation:
_______________________________________________________________________________

7. Indian mail address:
_______________________________________________________________________________

8. Mailing address in your country:
_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

9. Address where you want the licence mailed, if issued: _______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

10. (a) Period of your proposed operation in India:

Beginning _________________ Ending ___________________

(b) Purpose of your visit to India: ______________________________________________________

11. i) If you have a Visa, state Type, date of issue, date of exp.: ________________________________________________________________________________

________________________________________________________________________________

ii) If you have a Passport, state Passport No., place where issued, date of exp., date of issue ________________________________________________________________________________

________________________________________________________________________________

12. i) Licence No. of amateur radio operator and station licence issued to you by your country (if possible, enclose a photocopy):

________________________________________________________________________________

ii) Expiration date of license:

________________________________________________________________________________

iii) Call sign:
________________________________________________________________________________

13. i) Name of country which issued your radio licence:
_______________________________________________________________

ii) Are you a citizen of that country:
_______________________________________________________________

14. List of address of each location (if any) at which you will reside or operate in India (Location, dates of stay: beginning, ending):

________________________________________________________________________________

________________________________________________________________________________

15. Briefly describe your itenary while in India:
________________________________________________________________________________

________________________________________________________________________________

16. Particulars of previous applications, if any, made by the applicant for issue of amateur licence:

________________________________________________________________________________

17. Particulars of apparatus to be used:

(i) Transmitting:
________________________________________________________________________________

(ii) Receiving:
________________________________________________________________________________

(iii) Particulars of aerials proposed to be used:
________________________________________________________________________________

18. Frequency bands desired to be used and types of modulations desired to be used (Bands/Modulations):

________________________________________________________________________________

19. Please enclose personal description on a separate sheet of paper on the following points (in duplicate) 1. Name (in full), 2. Date of birth, 3. Place of birth, 4. Age / Years, 5. Height cms, 6. Colour of eyes, 7. Colour of hair, 8. Complexion, 9. Any special particulars or marks.

20. Enclose two passport size photographs signed and dated on the front.

Place: __________________________ Signature of candidate: _______________________________

Date: ___________________________

21. Declaration:

I undertake to observe the conditions of the licenece and hereby certify that the apparatus herein described can and will be worked in accordance with the provisions of the Indian Wireless Telegraphy (Amateur Service) Rules, 1978.

Signature of the applicant: _______________________________________

Date: ______________________________________________________

(6 COPIES TO BE SUBMITTED)


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