Liberia Telecommunications Authority (LTA

)
12th Street, Sinkor
Methodist Compound
Monrovia, Liberia
West Africa

LTA-MH-100

ENTITY NAME:
APPLICATION #:
Every piece of Radiocommunications and Telecommunications Equipment used in the Republic of
Liberia must be Type Approved by the Liberia Telecommunications Authority (LTA).
TYPE OF LICENSE REQUIRED (Please Select One)
MF/HF Fixed & Landmobile Stations

Aeronautical Ground to Air Station (Glider, Hang Glider, & Balloon)

Marine MF/HF Fixed & Mobile Stations

Radio License-Aircraft (take-off weight more than 3,200 Kg)

Aeronautical MF/HF Fixed & Mobile Stations

Radio License-Aircraft (take-off weight more than 14,000 Kg)

Aeronautical Ground Station (Airlines)

Radio License for Aircraft (Glider, Hang Glider & Balloon)

Radio License-Aircraft (take-off weight more than 3,200 Kg/less than 14,000Kg)
Other (Please specify)..................................................................................................................................

Purpose of Service......................................................................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
Does the applicant, or any affiliate of the applicant, currently operate MF/HF/Aeronautical Station?
Yes

No

If Yes, identify the Licensee and the date issued?
Licensee......................................................................Date of Issuance…....………...................................................

...................................................Manufacturer........Emission Bandwidth................. Specify Frequencies to be fitted.....For Fixed or Mobile Station indicate the following:Time of Operation (Please Select One) Day Night Day & Night Number of Base Stations........dBi Antenna Height above Sea Level........................................................................................................................................................................................................... Marker Beacon Receiver.........................................Glide Path Receiver...........................................................................Radio Range Receiver.....................M THIS SECTION......................................................Manufacturer....................................................................... EQUIPMENT DETAILS Type of Transmitter......... Application Form for MF/HF Radiocommunications License Version one 2007 2 .................................Manufacturer...................... Type of Antenna..............................................Gain....................................... TRANSMIT RECEIVE TRANSMIT RECEIVE Preferred Frequency Band.....................................................W Type of Receiver....................................................................................................................Output Power............................................................... Type of Emission................................................... Traveling Route(s)...................................................................................Number of Mobile Stations.................... FOR AIRCRAFT ONLY Radio Compass Receiver..........

............................................................................................................................................................................................W Type of Transmit Antenna................................................................................. Name and Qualifications of Operator...................................................................................................Length.......................................................................................................... FOR SHIP OR COAST STATION ONLY Reserved Transmitter............THIS SECTION............................................... THIS SECTION...................................................................................................................................................................................................................... FOR AIRCRAFT STATION ONLY Aircraft Registration Marking..........GRT.................................................. ..........................................Output Power................................................ Name and Address of Accounting Authority.......... Port of Registry....................................................................................... Does the Aircraft have a takeoff weight greater than 20 tones? Yes No Does the Aircraft have more that 38 passenger Seats? Yes No Application Form for MF/HF Radiocommunications License Version one 2007 3 ................................. Location of Station......................................................................................................................................................................... FOR SHIP STATION ONLY [Use of Vessel] Trade Fishing Pleasure Name of Vessel................................................................................................... Name of Licensed Radio Dealer to Maintain Equipment...................................................................................Output Power................................... Latitude....................Output Power...............................................................................Longitude.................................................W Very High Frequency (VHF) Radio Manufacture...................................County..... Name of Previous User................................................................................................................................................... THIS SECTION...................W Type of Receive Antenna......................

CERTIFICATION STATEMENT We declare that we have not commenced provision or operation of any of the telecommunication stations or networks applied for in this application and every piece of information in this application is true and correct. inaccurate or incorrect. inaccurate or incorrect. The LTA reserves the right to impose penal sanctions against us under any applicable laws and regulations in force. and this is without prejudice to any civil remedies that the LTA could bring against us if any of the information declared in the application is found to be untrue. …………………………………………….. We further acknowledge that. any license granted by the LTA will be revoked without notice. We understand that approval from the LTA for this application is based on information declared in this application. ………………………………………… Signature ……………………………………………. should any of the information declared herein is found to be untrue. Stamp ………………………………………… Name Application Form for MF/HF Radiocommunications License Version one 2007 Date 4 .

....................................................................................................................................LTA Permission Granted! YES MF HF Aeronautical Application Number................................................................................................... License Type......................................................................................................................................................................................................................................................................................................................................................................................... ...........Expiration Date..................................................................... Application Form for MF/HF Radiocommunications License Version one 2007 5 ........................................................................... Reason(s)....................................................... NO.............................................................................. Signature ........................................................................................................................................................................ Date Issued...........................................MHz Name of Authorized LTA Personnel...............Official Use Only Date Application Received...................................................................................................................................................................................................................................Title.................................................................................................................................................................................................................................................................................................Date Application Processed....................................................... .............................. ................................................................................................... Frequency(ies) ....................................................................................................................................................................................................................... Comments:....................................................................................................................................................................

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