APPLICATION FOR A TEMPORARY AMATEUR RADIO LICENCE
1. :___________
Surname
2. I', i: ____
Given names
3. i i : _____________________________________________________________
Date and place of birth
4. : ______
Citizenship
5. i i : __________________________________________________
Permanent home address
______________________
6. :_____
Passport number
7. : ____
Call sign
8. i :______
Class of licence
9. i i i :_______________________________________
Required period for a temporary licence
10. i : ___________________________________________________________
Location of ARS installation
11. i: __________________________________________________
The details of former licences in Ukraine
12. , : ___________________________________________________________
Equipment to be brought
________________________________________________________
' i i'.
I pledge oneself that I'll completely observe all governmental regulations established for Amateur Radio in Ukraine.
i : ______________________ : ______________
Applicant's signature Date
10
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