COP-1

IMPORTANT: APPLICATIONS NOT SUBMITTED IN ACCORDANCE WITH THE

INSTRUCTIONS GIVEN IN PAGE 7 WILL NOT BE ENTERTAINED *

GOVERNMENT OF INDIA
MINISTRY OF COMMUNICATIONS & INFORMATION TECHNOLOGY

FORM OF APPLICATION
For
ADMISSION TO EXAMINATION FOR A CERTIFICATE OF PROFICIENCY IN
RADIO-TELEPHONY RESTRICTED (AERONAUTICAL)
The form when completed should be sent to: Roll No.
Assistant Wireless Adviser,
WPC Wing Regional Licensing
Office, Ministry of To be filled in by the applicant
Communications, 3rd Floor, Name & Postal address of applicant.
MTNL Telephone Exchange (Tel. no. & E-Mail address, if any)
Bldg. Charkop, Sector-5, SATYAVEER SINGH
Kandivali (W), S/O KASHINATH SINGH, 182,
Mumbai -400067
ASHOKPURAM COLONY, DAFI,
Tel No : +91 22 28683202/28672351,
Fax No. +91 22 28673214 VARANASI,UP-221011.
CONT. NO. +91-8601546382

(a) Centre* (b) Class of Examination & Part. (Tick whichever applicable)
MUMBAI
MUMBAI RTR (Aero) Full: ‫ٱ‬ RTR (Aero) Pt.I: ‫ٱ‬
Note:-Pt. I - Renewal by Test (copy of Indian Licence/ Foreign
Licence and Indian Permit to be submitted along with application.
Original Licence should be produced during examination for
verification)
(c) Month of examination: APRIL, 2023.

(d) Details of Bank Draft. @NTRP BHARATKOSH RECEIPT ENCLOSED OF RS 500/-.

(i) Name of State Bank of India branch.

(ii) No. and date (iii) Amount:- 500/-

(e) State, if appearing in any other class of COP Examination. (Tick appropriate box)
No. ‫ٱ‬ N/A Yes. ‫ ٱ‬N/A Specify class if yes:- N/A

• *Name of the centre, duly notified.

• @The Bank Draft should be obtained from any branch of the STATE BANK OF INDIA and
drawn in favor of PAO (HQ), DOT, NEW DELHI payable at STATE BANK OF INDIA,
NEW DELHI, Parliament Street, New Delhi. Service Branch (Code 7687). In case of payment
from Delhi, Banker’s cheque from State Bank of India is also acceptable.
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1. Name of Applicant (In Block Letters) NAME SURNAME

Name in Hindi, if possible.
SATYAVEER SINGH

2. Full postal address to which S/O KASHINATH SINGH, 182, ASHOKPURAM COLONY,
Communication to be sent DAFI, VARANASI, U.P – 221011.

3. Permanent Home Address SAME AS ABOVE.

4. Contact No. and E-Mail address if any +91-8601546382 & [email protected]

5. Description of Applicant:
(a) Height 1.72 Metres 172 Centimeters
(b) Colour of eyes BROWN
(c) Colour of hair BLACK
(d) Complexion WEATISH
(e) Mark of Identification MOLE ON LEFT HAND RING FINGER

6. Date of Birth: (*Please attach attested

copy of your School Leaving Certificate or
Matriculation Certificate) (Applicant should be of 18 years of age)
06/04/2001

7. Place of birth (with District and State) VARANASI U.P

8. Name of State to which you belong UTTAR PRADESH

9. (a) Are you a citizen of India by birth and /or domicile YES BY BIRTH
Note: A certificate to this effect in the form given at page 4 of the application may obtain from
persons duly authorised from time to time by the Central Government.

(b) If not, to which country you belong? N/A

10. Father’s name, address and nationality (if dead, state

Last address) SH. KASHINATH SINGH, 182, ASHOKPURAM COLONY, DAFI,
VARANASI, UP 221011. INDIAN.

11. Particulars of Certificates of Competency/Proficiency

If any, already held by the applicant:

Class of Certificate No. and date of issue Authority by whom issued

N/A N/A N/A

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12. Educational Qualification of the Candidate 12TH

(Please attach proof, a copy duly attested by a Gazetted officer of Central or State Govt.)

DECLARATION

1. 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 later date, the certificate and licence to
operate, if granted will be cancelled.

2. 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 or 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 the said apparatus.

3. I have carefully read and understood the rules contained in the Indian Wireless Telegraphy
(Commercial Radio Operators Certificates of Proficiency and licence to operate Wireless
Telegraphy) Rules, 1954 and undertake to abide by them.

Signature of Witness Signature of applicant

Name (in Capital Letters) Name (in Capital Letters)

Address : Date :
Place :

Date :
Place :
(To be witnessed by any responsible person)

I enclosed the following documents:

(i) NTRP RECIEPT for Rs…500/-….

(ii) Character and Nationality Certificate
(iii) Domicile Certificate, if any required.
(iv) Proof of Age (Applicant should be above 18 years of age on the date of
commencement of the examination)
(v) Photographs stamps size 3x4 cms – Two Nos. (One should be pasted in the space
provided in the Attendance Sheet, page no.6, and the second one should be enclosed
in an envelope and secured to the application form).
(vi) Enclosed a self addressed and stamped (Rs.5/- only) envelope of size 23X10 cm.

Signature of applicant
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*CERTIFICATE OF CHARACTER AND NATIONALITY

Certified that I have known Shri SATYAVEER SINGH Son of Shri KASHINATH
SINGH…..for the last…………….……..years ………months. He bears a good moral character
and is of ……INDIAN……….nationality. He is not related to me.

Place: Signature

Date: Name (in Capital Letters)

Designation & Address with Stamp

This certificate should be from any one of the following:

1. Gazetted Officer of Central or State Governments.

2. Member of Parliament or State Legislature
3. Sub-Divisional Magistrate/Officer or Tehasildar
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(This page will be posted to the candidate. Therefore it should be on a separate sheet of
paper)

GOVERNMENT OF INDIA, MINISTRY OF COMMUNICATIONS & INFORMATION

TECHNOLOGY (WPC WING), Regional Licensing Office, …MUMBAI..

ADMISSION CERTIFICATE

Shri…SATYAVEER SINGH… is hereby admitted to the following examination:

Examination Centre Roll No. Date Time

RTR (A) MUMBAI

1. Candidates must carefully study the following instructions for strict compliance:

i) No candidate will be admitted to the Examination Hall after half an hour from the
commencement of examination
ii) Candidates should bring their own pen, ink, pencil, erasures and drawing
instruments.
iii) Candidates shall not be allowed the help of any scribe to write answers for them.
iii) No candidate shall be permitted to leave the Examination Hall unless half an hour
has elapsed after the commencement of the paper.
iv) Candidates are not allowed to take mobile phone to the examination hall.

2. If the candidate is found guilty of impersonation or using or attempting to use unfair means
in the Examination Hall, he is liable to criminal prosecution and/or he may be debarred either
permanently or for a specified period from appearing in the examination.

THE CANDIDATES MUST ABIDE BY ANY OTHER INSTRUCTIONS WHICH MAY

BE GIVEN TO THEM BY THE CHIEF EXAMINER OR THE INVIGILATING OFFICER.

For Assistant wireless Adviser

to the Government of India
Candidate to write his postal address:

To
SHRI SATYAVEER SINGH,
S/O KASHINATH SINGH, 182, ASHOKPURAM
COLONY,DAFI,VARANASI,221011.
 (Please use an exclusive/separate sheet for this page
GOVERNMENT OF INDIA
MINISTRY OF COMMUNICATIONS & INFORMATION
TECHNOLOGY (WIRELESS PLANNING & COORDINATION WING)

ATTENDANCE SHEET

(To be filled by the Candidate, preferably typed and should be on a separate sheet of paper)

Class of Exam: Click the respective box. Paste recent FOR OFFICE USE ONLY
Photograph 3X4 cm
Part I only here. The Roll No:……………
photograph should
Part I & II be signed and dated Sl no of Lic. ……….
on the front.
Name of the Centre: RTR(A) Lic. No……
Date:………………..
MUMBAI

1. Name of the Candidate in BLOCK LETTERS SATYAVEER SINGH

2. Postal address where the licence to be posted.
S/O KASHINATH SINGH, 182, ASHOKPURAM COLONY, DAFI,
VARANASI, 221011.

3. Father’s name. KASHINATH SINGH

4. Date of birth. 06/04/2001

5. Place of birth. VARANASI UP

6. Nationality. INDIAN

7. Height in mtrs. 1.72 8. Colour of eye. BROWN 9.Colour of hair BLACK

10.Complexion WEATISH

11.Mark(s) of identification MOLE ON LEFT HAND RING FINGER

12. Particulars of Certificate of Proficiency Licence, if any, already held by the applicant.
(a) Class of Licence. NA (b) No. and date of Licence. NA (c) Issued by. NA

Date Subject Signature of the Candidate

1 2 3
Part I

Part II