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Radio Station License Application Form

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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Arvic Omila Lasaca
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144 views2 pages

Radio Station License Application Form

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.

Uploaded by

Arvic Omila Lasaca
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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 [Link] 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. [Link] 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.....-.-...--.-.."[Link].i.E'iiiici.{6i.--^],.--Fii,fieijij{'[Link]}irftE-.-l..[Link]
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|[Link] 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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