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Application for a licence to establish , maintain and work Amateur Wireless Telegraph Station by an Amateur Radio Society or Club or a School, College or an Institute or a University in India. ( See rules 6 & 8 ) .
1. Name and Address of the Amateur Radio Society / Club / School / Institute etc.
2. Particulars of the authorised Official of the Society /Club / School etc. in whose favour licence is desired : (a) Name ---- (b) Designation --- (c) Date of Birth --- (d) Place of Birth --- (e)Nationality --- (f) Occupation ---
3. (a) Category of licence applied for --- (b) Exact location of the station ---
4. Particulars of the Amateur Wireless Telegraph Station licence held by the Authorised Official : (a)Category of licence --- (b) No. --- (c) Date of issue ---
5. Particulars of the Amateur Radio Society or Club , School etc. : (a) If registered , give its particulars ---- (b) Incase of school,college or institute , give the name of the Board or University by which it is recogonised --- (c) Give in brief its aim and objectives --- (d) If affiliated to any Radio Amateur Organisation, give its particulars --- (e) Give the name of the Office Bearers --- (f)Mode of operation of the station including its normal hours of working ---
6. Particulars of the Apparatus to be used : (a) Category of the apparatus --- (b) Manufacturers name --- (c) Type No. --- (d) Frequency range --- (e) R.F.Power output ---
DECLARATION
I hereby Solemnly Declare that the foregoing facts are true and correct and nothing is false therein and nothing material has been concealed therefrom. I also agree that in case of any information given by me herein before is found false at a later date , the License , if granted , will be cancelled.
I further solenly give an undertaking that I will not either directly or indirectly divulge to any person, except when lawfully authorised or directed to dos so, the purport of any message which iI 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 the 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 licenced station shall not be made accessible to any unauthorised person at any time .
| Signature of the witness: Name : (in block letters) Address : Date : |
Signature of the Applicant : Name : (in block letters) Address : Date : |
Note : 1. An attested copy of the Birth Certificate or school leaving certificate must be accompanied along with the application.
2. Enclose the certificate in support of Nationality in the prescribed proforma , indicated in Appendix III , from one of the Officers listed therein.
3. Attach a copy of the rules and regulation or Constitution.
4. Attach the minutes of the relevant meeting .
(See rule 9)
License No.
License to establish , maintain and work an Amateur Wireless Telegraph Station in India
Having satisfied , by examination or otherwise that Shri ------------ possess the requsite technical qualifications as prescribed under the Indian Wireless Telegraphs (Amateur Service) Rules ,1978, the Central Government in exercise of the powers conferred under the authority of sec.4 of the Indian Telegraph Act, 1885 (13 of 1885) , hereby grant to him an -------- to establish , maintain and work a Wireless Telegraph Transmitting and Receiving Station, detailed below , during the term of period commencing on the day of the date hereof and terminating on the -------- when this license becomes invalid unless renewed further by way of a document showing the renewal of licence. The licence is governed by the Indian Wireless Telegraphs (Amateur Service) Rules ,1978.
Particulars of the Station : (a)Location ---- (b) Call sign ---
Issued by the Government of India in the Ministry of Communications , New Delhi .Date.
(Sd.) Deputy / Assistant Wireless Advisor to the Government of India.
Signed. by the Licencee in the presence of ------ dated
Signature of the Licencee ------ dated.
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