Application for Amateur Radio License

Surname: _____________________________________ First name(s): ______________________

Nationality: ____________________________________ Occupation: _______________________

Birthplace: ____________________________________ Date of birth: ______________________

License number: ________________________________ Expiration date: ____________________

Call sign: ______________________________________Country of issue: ___________________

Class of license: ________________________________________________________________

Proposed operation on: ________________________________ (Island of Neth. Antilles)

from: _______________________________ to: ________________________ (dates)

Frequency band(s): ______________________________ Type(s) of emission: ________________

Description of Xmtr: _____________________________________________________________

Fixed Portable Mobile: ____________________________ XMTR. Power Input: ______ Watt ____

Location if fixed: ________________________________________________________________

Mailing address in Neth. Antilles: ____________________________________________________

Mailing address in your country: _____________________________________________________

The undersigned request a permit to operate an amateur radio station in the Netherlands Antilles and agrees that if a permit is granted his/her operation will be in according with:

1. The Rules of the Geneva Radio Regulations governing amateur radio operation.

2. The terms and conditions of the amateur radio license issued to me by my government.

3. The terms and conditions of the bilateral agreement on this subject between my government and the government of Netherlands Antilles.

4. Any further conditions attached to the permit by the government of the Netherlands Antilles.

I further understand that any permit issued to me may be summarily modified, suspended or cancelled without advance notice. I certify that all the information submitted herein or herewith are true, correct and complete to the best of my knowledge.

Cheque enclosed ... |__|
Cash enclosed ....... |__|

Date signed: ___________________________ Signature: _________________________________

This application form must be completed and returned to the Director of Landsradio, P.O.Box 103, Willemstad, Curacao, Netherlands Antilles, accompanied by a photostat of your valid license and an international bankdraft for $ 15.00 payable to Landsradio or $ 15.00 in cash to cover your license fee, the processing and airmailing of your license. Personal cheques will not be accepted.

Additional conditions under which a permit is granted:

1. The permit is valid for the period of one year.

2. The applicant must be over 15 years of age.

3. With the exception of the 160 meter band, the maximum power input is 1000 watts for the bands below 30 MHz and 150 watts for the bands above 50 MHz.

4. The amateur bands in the Netherlands Antilles are:

1800 to 1850 kHz; 1950 to 2000 kHz; (150 watts power input only)
3500 to 4000 kHz;
7000 to 7300 kHz;
10100 to 10150 kHz; (A1A and F1A only at 250 watts input)
14000 to 14350 kHz;
18068 to 18168 kHz; (A1A only at 250 watts input)
21000 to 21450 kHz;
24890 to 24990 kHz; (A1A only at 250 watts input)
28000 to 29700 kHz;

50 to 54 MHz;
144 to 148 MHz;
220 to 225 MHz;
430 to 440 MHz;
1215 to 1300 MHz;
2300 to 2450 MHz; and all other bands where amateur operations are permitted with the exception of the band between 902 and 928 MHz.

5. Types of emission allowed are A1A, A2A, F1A, F2A, F3E, G3E, H3E, J3E and R3E.
The use of other types of emission is subject to previous written approval of the Director of Telecommunications of the Netherlands Antilles.

6. The licensee should all times allow inspection of his equipment by the government radio inspector and follow all instructions given to him closely.

7. The cost of assigning and or processing special event call signs is $ 25.00.