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    Application Form For Radio Station License

    Uploaded by

    Ivan c Tanega
    The document is an application form for a radio station license from the National Telecommunications Commission of the Philippines. It requests information such as the type of applicant (government, non-carrier, etc.), class of station, frequency bands, service area, transmitter equipment details, and certification from the authorized representative. The back of the form lists the documentary requirements for new applications such as a duly accomplished form, construction permit copy, and business permit copy. Renewal applications require the accomplished form and original license copy.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form For Radio Station License

    Uploaded by

    Ivan c Tanega
    124 views2 pages
    The document is an application form for a radio station license from the National Telecommunications Commission of the Philippines. It requests information such as the type of applicant (government, non-carrier, etc.), class of station, frequency bands, service area, transmitter equipment details, and certification from the authorized representative. The back of the form lists the documentary requirements for new applications such as a duly accomplished form, construction permit copy, and business permit copy. Renewal applications require the accomplished form and original license copy.

    Original Title

    Application Form for Radio Station License

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    The document is an application form for a radio station license from the National Telecommunications Commission of the Philippines. It requests information such as the type of applicant (government, non-carrier, etc.), class of station, frequency bands, service area, transmitter equipment details, and certification from the authorized representative. The back of the form lists the documentary requirements for new applications such as a duly accomplished form, construction permit copy, and business permit copy. Renewal applications require the accomplished form and original license copy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    124 views2 pages

    Application Form For Radio Station License

    Uploaded by

    Ivan c Tanega
    The document is an application form for a radio station license from the National Telecommunications Commission of the Philippines. It requests information such as the type of applicant (government, non-carrier, etc.), class of station, frequency bands, service area, transmitter equipment details, and certification from the authorized representative. The back of the form lists the documentary requirements for new applications such as a duly accomplished form, construction permit copy, and business permit copy. Renewal applications require the accomplished form and original license copy.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    NTC Form No.

    : APPL-03
    Republic of the Philippines Reference Na:
    NATIONAL TELECOMMUNICATIONS COMMISSION
    Agham Road, East-Triangle, Diliman, Quezon City

    APPLICATION FOR RADIO STATION LIGENSE


    INSTRUCTIONS: All blanks must be filled up properly. Put 'n/a' for items not applicable to you. upon
    completion of the form submit this together with required/supporting documents. Print all
    entries in block or CAPITAL LETTERS

    i-::j Govemment i::::j Non-carrier [:::] PRS i__--j Amateur i____jOthers:


    wPc; [:::] New !::::l Ren NuMBER.OF YEARS;|---] One i.---i Tralo i---l Thr:ee

    GLASS OF STATION (s):


    No. of Stations per Classification(s)
    Repeater Land Mobile
    Fixed/Land Base (F)UFB) Portable
    Fixed (FX) Others
    Land Base (FB)
    1 APPLICANT
    2 BUSINESS ADDRESS
    3 CONTACT NO (s) EMAIL ADD.:
    4 $TATION LIG€$ISE I{O, (lf Ap$icable)
    5 FREQUENCY (tES) CH1 cH4
    CH2 cH5
    CH3 cH6
    6 SERVICE AREA/ POINT OF COMMUNICATION i
    7 PARTICUI ARg TRANSCEfiTER Et(lUlfi'lrEfTFfSTATtOf{: (For Nup FtsL onry. us6 sopaftfie Eheets if n6c€$ary)

    :....;:;i;;,,.....,.....,........"-""-----n"--___----__----_-__-+_--__
    i TyperModel ! i --i'--*---- --- l ---*-----^-^i
    ! SedalNumber i : i :

    i BW& Efii-r6s'rod i i i i :

    : Power OutDut ! i : : i
    :: ofAftcnna !!
    Tvia
    Type ^f
    lt-+---o !
    !
    ; ; :

    i Antenna Heism ! i : : i
    : Anbnn. Pol.riz.tion i i i ! i
    ;4fl|tenft6.1ft i i i i

    i Coordlnat€ i ! i i i

    *For Mobile Station; Specify the


    Type of Vehicle and its Plate Number under Exact Location.

    ai.....-.-...--.-.."t.iatu.euij.i.E'iiiici.{6i.--^],.--Fii,fieijij{'cs.tjF.eEHii}irftE-.-l..Expi.fAii
    ii
    ::ii
    I eERTIFGIITIO{I}
    t HEREBY CER FY that the above entries are tru€ and conect, that the radio station(s) shall be instalted
    /constructed in accordance Wth the pr€scribed standards and in conformity with the existing Radio Laws and
    Regulations and that I shall be liable for any willfu false statements made in this application under the Revised
    Penal CodE of the Philippines.

    Authorized Representative Date


    Signature over Printed Name of Applicant

    oRx^'i= ,20-
    AMOUNT:

    i cAsHtER

    PLEASE sEE BACK HEREoF FoR rHE REQuIREMENTS ro BE SUBMITTED i[a;;:l-Hl*t::::::::


    THIS FORM /S NOT FOR SALE AND CAN BE REPRODUCED
    D|OCI.IN ENTARY REQWREN ENrc FOR S{.I#SS'O'V
    NEW ,

    1 Duly Accomplished Form


    2 Copy of Construcfion Pormit (lf Applicable) |
    3 Copy of Business Permit/DTl/SEC Registation
    4 Copy of Permit to Possess

    RENEWAL
    1 tlrly Accomplisherl Form
    2 Originalcopy of Licenee to be renevysd

    iITC REGIOML OFFICE NO.:


    Office Address:
    Contact No.:
    Fax No.:
    E-mailAddress:

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