Registration Form Class Licence Devices-Form R-CL

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Instructions:
1. One (1) printed copy of this registration form must be completed and submitted.
2. If you are completing this form by hand, please write in block capitals and use a pen.

A.GENERAL INFORMATION
Registrant:
Title:
First Name:
Last Name:
Contact Information:
Title:
First Name:
Last Name:
Position:
Mailing Address:
Street 1:
Street 2:
Town/City:
Telephone:
Mobile:
Fax:
Email:

B. TRANSMITTER CHARACTERISTICS

	Base Station	Station 1	Station 2
Type of Class Licensed Device
Manufacturer Make
Manufacturer Model
Frequency Range of Operation
RF Output Power (Watts/dBm)

C: ANTENNA CHARACTERISTICS

	Base Station	Station 1	Station 2
Manufacturer Make
Manufacturer Model
Antenna Gain (dB)
Average Height above ground (m)
Azimuth (degrees)
Beam width (degrees)
Polarization
Geographical Location (degrees, minutes, seconds)

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. If the licence is granted, I am fully aware of all the obligations and conditions associated with the licence. I understand that in processing this application, the Authority may undertake such investigations as it considers appropriate to verify the information submitted and/or to assess the background or suitability of any person involved or to be involved in any permission or authorisation hereby applied for, and I hereby expressly consent for myself and on behalf of the applicant(s) and all such persons, to the carrying out by the Authority of such investigations. I confirm that I am duly authorised by all the relevant persons to make this declaration.

Name of individual authorised to sign on behalf of company (Block Capitals):

Registrant:

Title:

First Name:

Last Name:

Signature:

Date:

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