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Form No. NTC 1-03 APPLICATION FOR AMATEUR RADIO OPERATOR CERTIFICATE - AMATEUR RADIO STATION LICENSE

This document is an application form for an amateur radio operator certificate or amateur radio station license from the National Telecommunications Commission of the Philippines. The form requests information such as the applicant's name, address, contact details, call sign if previously assigned, and examination details. It also asks for equipment particulars if applying for a station license. The applicant must declare that the information provided is true and correct, and consents to the collection and processing of personal information according to the Data Privacy Act of 2012.

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Jon Cabales
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373 views1 page

Form No. NTC 1-03 APPLICATION FOR AMATEUR RADIO OPERATOR CERTIFICATE - AMATEUR RADIO STATION LICENSE

This document is an application form for an amateur radio operator certificate or amateur radio station license from the National Telecommunications Commission of the Philippines. The form requests information such as the applicant's name, address, contact details, call sign if previously assigned, and examination details. It also asks for equipment particulars if applying for a station license. The applicant must declare that the information provided is true and correct, and consents to the collection and processing of personal information according to the Data Privacy Act of 2012.

Uploaded by

Jon Cabales
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
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Republic of the Philippines Form No.

NTC 1-03
NATIONAL TELECOMMUNICATIONS COMMISSION Revision No. ___ ___02
Revision Date 03/31/2023
BIR Road, East Triangle, Diliman, Quezon City

APPLICATION FOR AMATEUR RADIO OPERATOR CERTIFICATE/


AMATEUR RADIO STATION LICENSE
INSTRUCTIONS:
(1) Accomplish this application form properly, in ALL CAPS, handwritten or computer-printed.
(2) Attach the complete requirements including supporting documents. For the List of requirements,
please refer to the NTC Citizen's Charter at the NTC website: ntc.gov.ph
(3) Check (✔) appropriate box. Indicate "N/A" for items not applicable.

TYPE OF APPLICATION TYPE OF PERMIT/ CLASS OF STATION


NEW LICENSE/CERTIFICATE Class A
RENEWAL Amateur Radio Operator Certificate Class B
MODIFICATION due to Amateur Radio Station License Class C
Class D
Club Radio Station License
Name of Club
Assigned Freq.
Temporary Permit for Foreign Visitor
NO. OF YEARS Special Permit for Vanity/Special Call Sign
Preferred Call Sign/s:

APPLICANT'S DETAILS
Last Name Date of Birth (mm/dd/yy)
First Name Sex Male Female
Middle Name Nationality
Call Sign ATROC/ARSL No. Validity (mm/dd/yy)
Unit/Rm/House/Bldg No. Street
Barangay City/Municipality
Province Zip Code
Contact Number Email
EXAMINATION DETAILS
Place of Exam Date (mm/dd/yy) Rating
PARTICULARS OF EQUIPMENT (Use separate sheet/s, if necessary)
Make Type/Model Serial Number Frequency Range

DECLARATION
I hereby declare that all the above entries are true and correct. Under the Revised Penal Code, I shall be held liable for any willful false statement(s)
or misrepresentation(s) made in this application form that may serve as a valid ground for the denial of this application and/or cancellation/revocation
of the permit issued/granted. Further, I am freely giving full consent for the collection and processing of personal information in accordance with
Republic Act No. 10713, Data Privacy Act of 2012.

Signature over Printed Name of Applicant

Date Accomplished

THIS FORM IS NOT FOR SALE AND CAN BE REPRODUCED

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