REPUBLIC OF THE PHILIPPINES

Department of Transportation and Communications

NATIONAL TELECOMMUNICATIONS COMMISSION
Quezon City

APPLICATION FOR AMATEUR RADIO OPERATORS' EXAMINATION

Check CLASS of examination being applied for:
[ ] Class "A" Elements 8, 9 & 10 (Element 1 - Code) 1x 1
[ ] Class "B" Elements 5, 6 & 7 picture
[ ] Class "C" Elements 2, 3 & 4
[ ] Class "D" Element 2 Only

Place of Exam Date of Exam

APPLICANT
PRINT (last name) (first name) (middle name)
MAILING ADDRESS
Tel. Nos.
DATE OF BIRTH Place of Birth
CITIZENSHIP AGE Civil Status: (Married/Single)
Latest Amateur Radio Examination Taken (For Re-examination):
State Class, Date and Place of Examination:

Applicant is:
[ ] Holder of valid First Class Radiotelephone/Radiotelegraph Operator Certificate
[ ] Registered Electronics and Communications Engineer
[ ] Holder of Amateur Operator Certificate (Class )

Copy this in your costumary handwriting:

"This is to certify that I have read and understood the instruction in this application form"

SIGNATURE OF APPLICANT

Requirements to be submitted:
New Applicant Removal/Re-examination Upgrading
1. Copy of Birth Certificate, Baptismal Cert., 1. Copy of Report of Rating of previous 1. Authenticated copy of Amateur Radio
Passport, PRC License, Driver's License or examination taken. Station License.
any document which can serve as a basis for 2. Two (2) identical copies 1"x1" picture. 2. Two (2) identical copies 1"x1" picture
age and Filipino citizenship. 3. Two (2) self-addressed stamped 3. Two (2) self-addressed stamped
2. Proof of Attendance in a seminar envelopes. envelopes.
conducted by an NTC accredited amateur 4. P50.00 Examination Fee 4. P50.00 Examination Fee.
club. NOTE:
3. Two (2) identical copies 1"x1" picture. New applicants who are graduates of BSECE or Holder of 1RTG/2RTG/1PHN
4. Two (2) self-addressed stamped envelopes must present their license/certificate to be qualified to take Class "B"
5. P50.00 Examination Fee examination directly.
TO: THE CHAIRMAN, Radio Operators Examination Committee

PLEASE ADMIT Mr/Ms.

with mailing address at
in the amateur radio operator examination indicated below:

[ ] Class "A" Elements 8, 9 & 10 (Element 1 - Code) 1" x 1" Picture

[ ] Class "B" Elements 5, 6 & 7
[ ] Class "C" Elements 2, 3 & 4
[ ] Class "D" Element 2 Only
NOTES:
1. Examination starts at 8:00 AM or as designated two days before the date of examination
2. Examinees late for more than 30 minutes will be considered absent.
3. Request for re-schedule of examination must be filed at least 1 week before the date of examination

Date of Exam: Place of Exam:

GLENN ANTHONY C. MERCADO

Chief, Safety Radio Services
& STCW Compliance Division