Amateur Radio Application

Personal Details

1. Full Name: *
E-mail Address (enter valid email) : *
2. Postal Address: *
3. Nationality : *
Date of Birth: *
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Place of Birth :
4. Age :
Passport Number : *
Country of Issue : *

5. If the applicant is under 21 years of age the following information should be filled out. If not skip to number 6.

a. Full Name of parent/guardian:
b. Parent/Guardian Nationality :
c. Relationship to the applicant :
d. Parent/Guardian Postal Address :
6. Particulars of any experience in working wireless transmitting apparatus :
7. Particulars of any certificates of proficiency in radio telegraphy :
8. Speed at which the applicant can send and receive in the mores code :

Overseas Applicant ONLY

9. Address to which the correspondent should be sent in your country :
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10. Address in Kiribati to which the correspondence should be sent :
11. Is this application for a Fixed or for a Mobile license? :
12. State the address or location at which the station will be operated :
Operation Start Date: *
 /  / 
Operation till when? : *
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13. State the reason for applying : *
14. Please upload the current amateur license issued to you by your own country :
Please upload your passport front page details as well : *

15. Particulars of apparatus to be used.

a. For Transmission

(Transmission) Manufacturer : *
(Transmission) Model Number : *
(Transmission) Serial Number : *
(Transmission) Power Output : *

b. For Reception

(Reception) Manufacturer:
(Reception) Model No :
(Reception) Serial No :
(Reception) Power Output :
c. Frequencies installed in apparatus or proposed frequency bands :
d. Type of aerial to be used :
e. Source of Power to be used :
f. Method of frequency control:
g. Method of frequency measurement e.g WWV, WWVH:
I certify that to the best of my knowledge and belief the information which I have given above, is true : *
Word Verification:
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