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:
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8. Mailing address in your country:
_______________________________________________________________________________
_______________________________________________________________________________
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9. Address where you want the licence mailed, if issued: _______________________________________________________________________________
_______________________________________________________________________________
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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):
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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):
________________________________________________________________________________
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15. Briefly describe your itenary while in India:
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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:
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(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):
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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)