1. Full Name of Applicant
2. Postal Address
3. Nationality
Place of Birth
Passport Number (if any)
4. Age Date of Birth
5. If applicant is under 21 years of age the following information is to be given
a. Full name of parent or guardian
b. Nationality
c. Relationship to Applicant
d. Postal Address
6. Particulars of any experience in working wireless transmitting apparatus.
7. Particulars of any certificates of proficiency in radio telegraphy or telephony.
8. Speed at which the applicant can send and receive in the morse code.
9. (Overseas applicants only)
Address to which correspondence should be sent in your country. Add dates if
relevant.
10. Address in Kiribati to which correspondence should be sent. Add dates if relevant.
11. Is this application for a fixed or for a mobile licence? (Separate licences are required for each).
12. State the address or location at which the station will be operated, and for what period.
13. State reasons for applying.
14. Do you wish to apply for a licence under a Reciprocity Agreement? If so please attach the current amateur licence issued to you by your own country or a facsimile of same.
15. Particulars of apparatus to be used.
A. For transmission
Manufacturer
Model
Serial Number
Power Output
B. For reception
Manufacturer
Model
Serial Number
C. Frequencies installed in apparatus or proposed frequency bands
D. Type of Aerial to be used
E. Source of power to be used
F. Method of frequency control
G. Method of frequency measurement (if by crystal calibrator, state if provision made for checking this against standard frequency broadcasts e.g. WWv, WWVH).
I enclose facsimile licence referred to in para 15 above.
I certify that to my knowledge and belief the information which I have given above is true.
Date: __________________________________ Signature: ______________________________________
Notes on Completion:
1. Where space is in sufficient, information should be written on a separate sheet and attached to the application.
2. Items 6, 7 and 8 if no experience or qualification insert "NONE"
3. Items 15. Makes details will usuallly be found either on the back of the apparatus, inside of the cover or in the handbook supplied. If difficulty in providing full answers to this item experienced consult the Chief Executive Officer, Telecom Services Kiribati Ltd, Bairiki, Tarawa, Republic of Kiribati.
From G0FSJ