|
Application from an individual for a licence to establish, maintain and work
an Amateur Wireless Telegraph Station in India.
(See rules 6 & 8)
1.Name:
.
(Last name)
(First) (Middle)
2. Father's name and
address :
3. Address
(Present) :
4. Address
(Permanent) :
5. Date of
Birth Place of Birth
Nationality Occupation
6. (a) Category of licence
applied for (b) Exact location of the Station
7. Do you hold
Radiotelegraph Operator's Certificate? If yes, give particulars:
Name of the
certificate
No. Date of Issue
8. Particulars of Amateur
Station Operator's Examination:
Name Centre Month
of Examination
9. Particulars of apparatus
to be used:
Apparatus used |
Manufacturer's Name | Type No. | Frequency Range | R.F. Power Output
Transmitter
Receiver
Frequency Measuring Device
10. If appeared in any of the
Amateur Station Operator's Examination. Yes/No
If yes, indicate the
date of the examination
DECLARATION
I hereby solemnly declare that
the foregoing facts are true and correct and nothing is false therein and
nothing material has been concealed there from. I also agree that in case
any information given by me herein before is found false at a later date,
the licence, if granted, will be cancelled.
I further solemnly give an
undertaking that I will not either directly or indirectly divulge to any
person, except when lawfully authorised or directed to do so, the purport of
any message which I may transmit or receive by means of any wireless
apparatus operated by me or which may come to my knowledge in connection
with the operation of said apparatus.
I have carefully read and
understood the rules contained in the Indian Wireless Telegraphs (Amateur
Service) Rules, 1978 and undertake to abide by them and observe the
conditions of the licence. The licensed station shall not be made accessible
to any unauthorised person at any time.
Signature of
witness: Signature of
applicant:
Name (in block
letters): Name (in bock
letters):
Address:
Address:
Date:
Date:
Place:
Place:
Note
1.
An
attested copy of birth certificate or school leaving certificate must be
accompanied along with the application.
2.
Enclose a certificate in support of nationality in the prescribed
Performa, indicated in Appendix III from one of the officers listed therein.
3.
Enclose 2
passport size photographs duly signed in the front by the candidate.
4.
The exam fee is
as follows: Grade II & Restricted Grade II Rs.10 each, Grade I Rs.20 and
Advance Grade Rs.25. The exam fee should be paid in the form of Demand
Draft drawn only from State Bank of India in favour of Pay & Accounts
Officer (HQ), D.O.T.
New Delhi
and payable at New Delhi Service Branch No.7687.
THE
FOLLOWING DETAILS MAY ALSO BE FURNISHED
(Four Copies
of this page are to be submitted)
1.
Name in full (block letters) :
2.
Date of birth :
3.
Place of birth :
4.
Age :
5.
Height :
6.
Colour of eyes :
7.
Complexion :
8.
Colour of hair :
9.
Identification marks :
10.
Full address (block letters) :
Pin:
11.
Occupation
(Major
work or profession for
which
you receive money)
12.
Nationality : Indian
13.
Fathers name and home address :
(Aliases if any)
Pin:
14.
Particulars of previous applications
if any
made by the applicant for the
issue of
Amateur Licence :
15. Type of
Licence applied for : ASOL Restricted Grade II/Grade II/ Grade
I/
Advance Grade
16.
Exact location of station :
(Full
address in block letters)
Pin:
Date:
(Signature of applicant)
APPENDIX
III
NATIONALITY
CERTIFICATE
Certified that I have known
Shri./Smt/Kum ................................................. son/daughter
of Shri.................................................... for the
last............ years and that to the best of my knowledge and belief
he/she bears a good moral character. He/She is of ..
.......nationality.
He/She is not related to me.
Address:
Signature:
Dated:
Designation:
Seal:
Note-
This certificate should be from one of the officers listed below:-
1.
Gazetted officers of Central or State Governments.
2.
Members of Parliament or State Legislatures.
3.
Sub-Divisional Magistrate/Officer.
4.
Tahsildars or Naib/Deputy Tehsildars Authorised to exercise magisterial
powers.
5. Principal / Head Master /
Head Mistress of the recognized institutions (School / College)
Form
K-1
Government of
India
Ministry of
Communications
Department of
Telecommunications
Monitoring
Organisation
Ref. No :
L
Wireless Monitoring Station
To
Dated:
Sub: Result of Amateur Station Operators Certificate
- Advance / Grade I /
Grade II / Restricted examination held
at
on Roll
No:
Sir/Madam,
I
am directed to inform you that:-
i)
You have been declared successful in the ASOL Restricted
Grade II / Grade II / Grade I / Advance Grade Examination. The papers are
being forwarded to the Assistant Wireless Advisor to the Government of
India, W.P.C. Wing, Ministry of Communications,
New Delhi. As
soon as a decision is taken to grant you a licence, you will be informed by
the Ministry accordingly. You are requested not to send any money to the
Ministry, unless asked for.
ii)
You have not qualified in the ASOL Restricted Grade II /
Grade II / Grade I / Advance Grade examination
iii)
Communication regarding grant of licence will be sent to you
by the Assistant Wireless Advisor to the Government of India, Ministry of
Communications,
New Delhi
in due course.
Further
correspondence if any, on this subject may be had with Assistant Wireless
Advisor to the Government of India, Ministry of Communications, New Delhi
only.
Yours
faithfully,
(
)
Officer-in-Charge,
Monitoring
Station.
Copy to:-
The
Assistant Wireless Advisor to Govt. of India,
Ministry of
Communication & Information Technology,
Department
of Telecommunications, WPC Wing,
Amateur
Section, Room No.619, Sanchar Bhavan,
Parliament
Street, New Delhi 110 001.
(Kind Attn:
Sri )
(Note: Two
copies of this page are to be submitted)
Download Application Form
|
