Amateur Radio Licence Application Form

Amateur Radio Licence Application Form - Form L2

Click here for a blank PDF version of this form Instructions: 1. Type or write in BLOCK CAPITAL letters with the use of a pen. 2. The Original and a copy of Amateur Radio Certificate must be submitted. 3. The Original and a copy of previous and/or existing licence must be submitted. 4. The Original and a copy of Trinidad and Tobago's National ID or Passport must be submitted. 5. All sections of this form must be completed. 6. The submissions checklist below must be accurately completed. SUBMISSION CHECKLIST Please ensure that the following have been submitted:

ITEM	DESCRIPTION	CHECK BOX IF SUBMITTED
Form L2	Completed all sections
A	Original and a copy of Trinidad and Tobago's National ID or Passport
B	Original and copy of Amateur Radio Certificate
C	Original and a copy of previous and/or existing Licence
D	Original and a copy of a valid Licence issued by another Country (only applicable for an applicant requesting a Reciprocal Licence)

A. GENERAL INFORMATION
Name of Applicant:

Title:
First Name:
Last Name:
Address:
Street 1:
Street 2:
Town/City:
Mailing Address if different from above:
Street 1:
Street 2:
Town/City:
Telephone:
Fax:
Email:
Address of Base Station:
Street 1:
Street 2:
Town/City:
Nationaity:

Individual:
Club:
Name of Club:
Certifying Body:
New Applicaition:
Preferred Call-sign:
Reiprocal Licence Must Complete Section B

B. LICENCE INFORMATION FOR RENEWAL AND RECIPROCAL APPLICANTS ONLY

Class of Licence:
Current Licence issued by: Name of Agency:
Name of Agency:
Address:
City:
State:
Country:
Call Sign:
Permit Number:
Date of Issue:
Expiry Date of Licence:
Passport Number:
Duration of stay in Trinidad and Tobago:

Date From:

Date To:

Duration of Licence Requested:

Date From:

Date To:

C. EQUIPMENT TECHNICAL SPECIFICATION

	Quantity	Make	Model	Serial Number	Date Purchased
Fixed Station(s):
Mobile(s):
Portable(s):
Base Station(s) (Repeaters):

D. DECLARATION AND SIGNATURE

I, the undersigned, do hereby declare that the information provided in this application is correct and accurate to the best of my knowledge. I acknowledge and agree that submitting an application to the Telecommunications Authority of Trinidad and Tobago does not mean that a licence will be granted, and that consideration of this application is a matter for the exercise of the Authority's discretion acting in accordance with the Telecommunications Act, 2001.

Applicant:

Title:

First Name:

Last Name:

Signature:

Date:

Remove

Add