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AmeteurRadioApplication Form

This document is an application form for an amateur radio operator's license issued by Sri Lanka's Telecommunications Regulatory Commission. It requests information such as name, nationality, date of birth, contact details, academic and technical qualifications from applicants. Applicants must select the category of license they are applying for, such as Novice Class, General Class or Advanced Class. For the Advanced Class, applicants must indicate if they wish to take the written exam, practical Morse code test, or both. They must sign a declaration confirming the accuracy of the information and agreeing to abide by the exam rules and regulations. A referee also needs to attest to the applicant's identity and signature.

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VAS TECHNOLOGY
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43 views3 pages

AmeteurRadioApplication Form

This document is an application form for an amateur radio operator's license issued by Sri Lanka's Telecommunications Regulatory Commission. It requests information such as name, nationality, date of birth, contact details, academic and technical qualifications from applicants. Applicants must select the category of license they are applying for, such as Novice Class, General Class or Advanced Class. For the Advanced Class, applicants must indicate if they wish to take the written exam, practical Morse code test, or both. They must sign a declaration confirming the accuracy of the information and agreeing to abide by the exam rules and regulations. A referee also needs to attest to the applicant's identity and signature.

Uploaded by

VAS TECHNOLOGY
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
You are on page 1/ 3

TELECOMMUNICATIONS REGULATORY COMMISSION OF SRI LANKA

APPLICATION FORM
For office use only
EXAMINATION FOR THE ISSUE OF AMATEUR RADIO OPERATOR’S File No:
LICENCE BY THE DIRECTOR GENERAL OF TELECOMMUNICATIONS Index No:
Date of Submission:

1. Category of Licence Required:


(if applicant is willing to apply for more than one category applicant should submit a separate
application form for each category)
Novice Class
General Class
Advanced Class
2. Full Name (IN BLOCK CAPITALS):

3. Name with Initials: Rev./Dr./Mr./Mrs./Ms. (IN BLOCK CAPITALS)

4. Nationality:
5. Date of Birth: Age as on the closing date of the Application:

D D M M Y Y Y Y Years Months Days


*Photocopy of the Birth certificate should be attached.

6. Gender: Male
Female

7. National Identity Card Number:

8. Contact Details:

PAGE 1 OF 3
Residence Office
Address

Email
Telephone Home: Mobile: Office:

9. Academic Qualifications (Masters/Degree/Advanced Level/etc.):


Masters/Degree/Advance Level/etc. Institute/School Year Grade

*Please attach copies of certificates.


10. Technical /Professional Qualifications (Evidence should be furnished)
Diploma/Professional Institute/Awarding Year Specialization Grade
Membership Body

*Please attach copies of certificates.


11. Please indicate whether you wish to attempt the written Examination and Practical Morse code
Test in case of Advanced Class Examination
I. Written Examination (Part 01)

II. Practical Morse Code Test (Part-02)

12. DECLARATION
I do hereby declare that to the best of my knowledge and belief the particulars furnished by me are true
and correct. I confirm that I have read and understood the examination rules & regulations as published
in the gazette notification and I agree to abide by these rules and regulations.

……………………………………………………. Date: …...... /………. /…………..


Signature of Candidate

PAGE 2 OF 3
ATTESTATION (Refer Gazette Notification)
I certify that ……………………………………………………………………………………………………………………………………….
Who is resident of …………………………………………………………………………………………………………………………….
And known to me personally placed/ his signature in my presence today.

Signature of Attester: ……………………………


Date: ………………………………………………….
Name: ………………………………………………...
Designation: ………………………………………….
Postal Address: ………………………………………

For office use only

1) Examination fee paid .…………………………………………………………..

2) General receipt number …………………………Dated………………………..

3) Observations / Remarks

PAGE 3 OF 3

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