TELECOMMUNICATIONS REGULATORY AUTHORITY

Beirut Central District Tel : 00961 1 964 300

Marfaa 200 Building, Lebanon Fax : 00961 1 964 341

APPLICATION FORM FOR AN AIRCRAFT RADIO LICENCE1

‫ﻃﻠﺐ ﺗﺮﺧﻴﺺ ﻻﺳﻠﻜﻲ ﻟﻠﻄﺎﺋﺮات‬
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FOR ADMINISTRATIVE USE ONLY

Type of Application ‫ﻧﻮع اﻟﻄﻠﺐ‬
‫ﻟﻼﺳﺘﺨﺪام اﻻداري ﻓﻘﻂ‬
NEW ‫ﺟﺪﻳﺪ‬ MODIFY ‫ﺗﻌﺪﻳﻞ‬ License No ‫رﻗﻢ‬ Ref. No
‫اﻟﻤﺮﺟﻊ‬
‫اﻟﺘﺮﺧﻴﺺ‬

RENEW ‫ﺗﺠﺪﻳﺪ‬ CANCEL ‫اﻟﻐﺎء‬ Date

‫اﻟﺘﺎرﻳﺦ‬

1. Applicant ‫ﻣﻘﺪّم اﻟﻄﻠﺐ‬

Full name of applicant (Company

1.1 or person)
(‫اﻹﺳﻢ اﻟﻜﺎﻣﻞ ﻟﻤﻘﺪّم اﻟﻄﻠﺐ )ﺷﺮآﺔ أو ﺷﺨﺺ‬

Address ‫اﻟﻌﻨﻮان‬
1.2

1.3 Telephone/Fax ‫ اﻟﻔﺎآﺲ‬/‫اﻟﻬﺎﺗﻒ‬

1.4 E-mail ‫اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬

1.5 Name of contact person

‫إﺳﻢ اﻟﺸﺨﺺ اﻟﺬي ﻳﻤﻜﻦ اﻻﺗﺼﺎل ﺑﻪ‬
1.6 Telephone/Fax ‫ اﻟﻔﺎآﺲ‬/‫اﻟﻬﺎﺗﻒ‬

1.7 E-mail ‫اﻟﺒﺮﻳﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬

Invoice Address – if different from

1.8 1.2 above
‫ﻋﻨﻮان اﻟﻔﺎﺗﻮرة ـ إذا آﺎن ﻣﺨﺘﻠﻔ ًﺎ ﻋﻦ اﻟﻌﻨﻮان‬
‫ أﻋﻼﻩ‬1.2 ‫اﻟﻤﺬآﻮر ﻓﻲ اﻟﺨﺎﻧﺔ‬

2. Business Details ‫ﺗﻔﺎﺻﻴﻞ اﻟﺸﺮآﺔ‬

Registered name of company

2.1
‫إﺳﻢ اﻟﺸﺮآﺔ اﻟﻤُﺴﺠﱠـﻞ‬

Trading name – if different from 2.1

above
2.2
‫اﻹﺳﻢ اﻟﺘﺠﺎري ـ إذا آﺎن ﻣﺨﺘﻠﻔ ًﺎ ﻋﻦ اﻹﺳﻢ‬
‫ أﻋﻼﻩ‬2.1 ‫اﻟﻤﺬآﻮر ﻓﻲ اﻟﺨﺎﻧﺔ‬

Company registration details

2.3
‫ﺗﻔﺎﺻﻴﻞ ﺗﺴﺠﻴﻞ اﻟﺸﺮآﺔ‬
Name(s) of owner(s), partner(s) or
Director(s)
2.4
(‫ اﻟﺸﺮﻳﻚ )اﻟﺸﺮآﺎء‬،(‫إﺳﻢ )أﺳﻤﺎء( اﻟﻤﺎﻟﻚ )اﻟﻤﺎﻟﻜﻴﻦ‬
(‫أو اﻟﻤﺪﻳﺮ )اﻟﻤﺪراء‬

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Please complete this form in BLOCK CAPITALS in dark ink or typescript. Please note that the technical information contained in this form might
be used in the coordination procedure with other users of the radio spectrum. Please keep a copy of the completed application form.
‫ آﻤﺎ ﻳُﺮﺟَﻰ اﻟﻤﻼﺣﻈﺔ أن اﻟﻤﻌﻠﻮﻣﺎت اﻟﺘﻘﻨﻴﺔ اﻟﻮاردة ﻋﻠﻰ هﺬا اﻟﻄﻠﺐ ﺳﻮف ﺗُﺴﺘﺨﺪم ﻓﻲ اﻹﺟﺮاء اﻟﺘﻨﺴﻴﻘﻲ ﻣﻊ‬.‫ﻳُﺮﺟَﻰ ﻣﻞء هﺬا اﻟﻄﻠﺐ ﺑﺄﺣﺮف آﺒﻴﺮة وﺣﺒﺮ ﻗﺎﺗﻢ أو ﻃﺒﺎﻋﺘﻪ‬
.‫ وﻳُﺮﺟﻰ اﻻﺣﺘﻔﺎظ ﺑﻨﺴﺨﺔ ﻣﻦ اﺳﺘﻤﺎرة اﻟﻄﻠﺐ اﻟﻤﻜﺘﻤﻠﺔ‬.‫ﻣﺴﺘﺨﺪِﻣﻴﻦ ﺁﺧﺮﻳﻦ ﻟﺤﻴّﺰ اﻟﺘﺮددات اﻟﻼﺳﻠﻜﻴﺔ‬

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3. Aircraft Details ‫ﺗﻔﺎﺻﻴﻞ اﻟﻄﺎﺋﺮة‬

3.1. Country of Registration ‫ﺑﻠﺪ اﻟﺘﺴﺠﻴﻞ‬

Aircraft Registration Mark
3.2.
‫ﻋﻼﻣﺔ ﺗﺴﺠﻴﻞ اﻟﻄﺎﺋﺮة‬
Previous Registration (if any)
3.3.
(‫اﻟﺘﺴﺠﻴﻞ اﻟﺴﺎﺑﻖ )إن ُوﺟِﺪ‬
Aircraft Use
3.4.
‫وﺟﻬﺔ اﺳﺘﺨﺪام اﻟﻄﺎﺋﺮة‬
3.5. Aircraft Type ‫ﻧﻮع اﻟﻄﺎﺋﺮة‬

3.6. Make / Model ‫ اﻟﻄﺮاز‬/‫اﻟﺼﻨﻊ‬

3.7. Serial Number ‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ‬

3.8 Call sign ‫ﻋﻼﻣﺔ اﻟﻨﺪاء‬

4. Equipment Details – Transmitters ‫ﺗﻔﺎﺻﻴﻞ اﻟﻤﻌﺪّات ـ أﺟﻬﺰة اﻹرﺳﺎل‬

4.1. Equipment Type ‫ﻧﻮع اﻟﻤﻌﺪات‬

4.2. Manufacturer ‫اﻟﻤُﺼﻨﱢﻊ‬

4.3. Part Number ‫رﻗﻢ اﻟﻘﻄﻌﺔ‬

4.4. Output Power (erp) ‫اﻟﻄﺎﻗﺔ اﻟﻤُﻨﺘﺠَﺔ‬

(W)
Class of Emission
4.5.
‫ﺚ‬
ّ ‫ﺻﻨﻒ اﻟﺒ‬
Frequency bands or assigned
4.6. frequencies
‫ﻧﻄﺎﻗﺎت اﻟﺘﺮدّدات أو اﻟﺘﺮدّدات اﻟﻤﺨﺼﺼﺔ‬

5. Equipment Details for Survival craft transmitters (when applicable) (‫ﺗﻔﺎﺻﻴﻞ ﻣﻌﺪّات أﺟﻬﺰة إرﺳﺎل اﻟﻨﺠﺎة )ﻋﻨﺪ اﻻﻗﺘﻀﺎء‬

5.1. Equipment Type ‫ﻧﻮع اﻟﻤﻌﺪّات‬

5.2. Manufacturer ‫اﻟﻤُﺼﻨﱢﻊ‬

5.3. Part Number ‫رﻗﻢ اﻟﻘﻄﻌﺔ‬

5.4. Output Power (erp) ‫اﻟﻄﺎﻗﺔ اﻟﻤُﻨﺘﺠَﺔ‬

(W)
Class of Emission
5.5.
‫ﺚ‬
ّ ‫ﺻﻨﻒ اﻟﺒ‬
Frequency bands or assigned
5.6. frequencies
‫ﺣﺰَم اﻟﺘﺮدّدات أو اﻟﺘﺮدّدات اﻟﻤﺨﺼﺼﺔ‬
ُ

Declaration
(to be signed by the Applicant)
‫إﻋﻼن‬
(‫)ﻳﻮﻗّﻌﻪ ﻣﻘﺪّم اﻟﻄﻠﺐ‬

I certify that the information on this form and any other information given in support of this application are correct. I confirm that no change will be
made in any of the foregoing equipment without prior approval of the Commission. I accept responsibility for ensuring that the aircraft is covered by
a valid Licence at all times. I agree to abide by all conditions of the Licence and any directions made by the Telecommunications Regulatory
Authority from time to time. I accept that the Licence cannot be transferred to another person, or used on another aircraft and is issued to both
myself and the aircraft as named on the Licence. I agree to abide by this condition and all other conditions attached to the Licence.

‫ي ﻣﻦ اﻟﻤﻌﺪّات اﻵﻧﻔﺔ اﻟﺬآﺮ ﺑﺪون‬

ّ ‫ي ﺗﻐﻴﻴﺮ ﻟﻦ ﻳُﺠﺮى ﻷ‬
ّ ‫ وأؤآّﺪ أن أ‬.‫ هﻲ ﻣﻌﻠﻮﻣﺎت ﺻﺤﻴﺤﺔ‬،‫ي ﻣﻌﻠﻮﻣﺎت أﺧﺮى ﻣﺮﻓﻘﺔ ﺑﻪ‬
ّ ‫ وأ‬،‫أﺷﻬﺪ أن اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﺬآﻮرة ﻓﻲ هﺬا اﻟﻄﻠﺐ‬
‫ آﻤﺎ أﻧﻨﻲ أواﻓﻖ ﻋﻠﻰ اﻟﺘﻘﻴّﺪ ﺑﺠﻤﻴﻊ ﺷﺮوط اﻟﺘﺮﺧﻴﺺ وأي‬.‫ وأﻧﺎ أﺗﻘﺒّﻞ ﻣﺴﺆوﻟﻴﺔ ﺿﻤﺎن ﺗﻐﻄﻴﺔ اﻟﻄﺎﺋﺮة ﺑﺮﺧﺼﺔ ﺻﺎﻟﺤﺔ ﻓﻲ ﺟﻤﻴﻊ اﻷوﻗﺎت‬."‫ﻣﻮاﻓﻘﺔ ﻣﺴﺒﻘﺔ ﻣﻦ "اﻟﻠﺠﻨﺔ‬

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‫ﺗﻮﺟﻴﻬﺎت ﺗﺼﺪر ﻋﻦ "اﻟﻬﻴﺌﺔ اﻟﻤﻨﻈّﻤﺔ ﻟﻼﺗﺼﺎﻻت" ﻣﻦ وﻗﺖ ﻵﺧﺮ‪ .‬وأﻧﺎ أرﺿﻰ ﺑﻌﺪم ﻗﺎﺑﻠﻴﺔ ﺗﺤﻮﻳﻞ اﻟﺘﺮﺧﻴﺺ إﻟﻰ ﺷﺨﺺ ﺁﺧﺮ‪ ،‬أو اﺳﺘﺨﺪاﻣﻪ ﻟﻄﺎﺋﺮة أﺧﺮى‪ ،‬وأﻧﻪ ﺻﺎدر ﻟﻲ‬
‫وﻟﻠﻄﺎﺋﺮة ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﻤُﺴﻤّﻰ ﻓﻲ اﻟﺘﺮﺧﻴﺺ‪ .‬وأﻧﺎ أواﻓﻖ ﻋﻠﻰ اﻻﻣﺘﺜﺎل ﻟﻬﺬا اﻟﺸﺮط وﻟﺠﻤﻴﻊ اﻟﺸﺮوط اﻷﺧﺮى اﻟﻤﺮﻓﻘﺔ ﺑﻬﺬا اﻟﺘﺮﺧﻴﺺ‪.‬‬

‫‪Signed‬‬ ‫_____________________‬ ‫اﻟﺘﻮﻗﻴﻊ‬

‫‪Title‬‬ ‫__________________________‬ ‫اﻟﻤﻨﺼﺐ‬

‫__________________ )‪Name (BLOCK LETTERS‬‬ ‫اﻹﺳﻢ )أﺣﺮف آﺒﻴﺮة(‬

‫‪Date‬‬ ‫__________________________‬ ‫اﻟﺘﺎرﻳﺦ‬

‫‪Checklist‬‬
‫‪Have you‬‬
‫?‪1. Completed all sections of the form applicable to you‬‬
‫?‪2. Signed the declarations‬‬
‫?‪3. Made a copy for reference‬‬
‫‪4. Now send your application to the address below:‬‬

‫‪Telecommunications Regulatory Authority‬‬

‫‪Marfaa 200 building‬‬
‫‪Beirut Central District‬‬
‫‪Beirut – Lebanon‬‬
‫ﻣﻼﺣﻈﺔ‬
‫هﻞ‬
‫‪ .1‬أآﻤﻠﺖ ﺟﻤﻴﻊ اﻷﻗﺴﺎم اﻟﻤﻄﻠﻮﺑﺔ ﻣﻨﻚ؟‬
‫‪ .2‬وﻗّﻌﺖ ﻋﻠﻰ اﻹﻋﻼﻧﺎت؟‬
‫‪ .3‬أﻋﺪدت ﻧﺴﺨﺔ ﻟﻠﺮﺟﻮع إﻟﻴﻬﺎ؟‬
‫‪ .4‬اﻵن‪ ،‬أرﺳﻞ ﻃﻠﺒﻚ إﻟﻰ اﻟﻌﻨﻮان اﻟﻤﺬآﻮر أدﻧﺎﻩ‪:‬‬

‫"اﻟﻬﻴﺌﺔ اﻟﻤﻨﻈّﻤﺔ ﻟﻼﺗﺼﺎﻻت"‬

‫ﻣﺒﻨﻰ اﻟﻤﺮﻓﺄ ‪200‬‬
‫ﻣﻨﻄﻘﺔ وﺳﻂ ﺑﻴﺮوت‬
‫ﺑﻴﺮوت ـ ﻟﺒﻨﺎن‬

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