APPLICATION FOR AN EXPERIMENTAL WIRELSS LICENCE
(to be submitted in quadruplicate)
(Two copies to be Submitted on the original form and two photocopies)
1. Name of Applicant (In Block Letters)
:
2. Postal Address
:
3. Nature of activity in which engaged
:
4. Particulars of any licence (issued by
the Ministry of Communications)
held at present
:
5. Type of licence required (please tick (  ) appropriate item)
a) Radiating
b)
i)
Design, development & testing of wireless apparatus.
Incase of manufacturers, the list of products and reference
of Letter of Intent (LOI) issued by Deptt. of Industrial
Development may be furnished.
ii)
Research and Experimentation, Brief details of proposed experiment may
be furnished.
Non-radiating i)
ii)
Training/Imparting instructions to students (indicate brief
details of courses conducted).
Servicing, maintenance and testing of wireless apparatus.
(The write up should cover salient points and may not exceed one page)
6. Technical parameters desired
:
a) Frequency range of equipment
:
b) Preferred frequency (ies), if any,
:
along with justification.
c) R.F. Power Output.
:
d) Emission & Bandwidth
:
7. Details of equipment held, if any.
8. i)
ii)
:
Location of wireless stations @/Factory (for industry)
Area of operation of mobile stations, if any.
9. Hours of working desired
(@Attach list on separate paper, if necessary):
DECLARATION
I/We hereby declare that (I) details above are correct & factual; (ii) the conditions imposed for the grant
of licence shall be observed; (iii) no unauthorised person shall be permitted to have access to the wireless
installations; (iv) I/We will not, without authorisation, divulge to any person the purport of message, other
than a message intended for the general use of the public which I/We may transmit or receive by wireless
equipment operated by me or which may come to my knowledge with the operation of the said
equipment.
Place & Date ………………………..
(SIGNATURE)
Government of India
MINISTRY OF COMMUNICATIONS
Telecommunication Commission
WPC Wing, Sanchar Bhawan, 2, Ashoka Road, New Delhi-1
To
Sub : Agreement in Principle for Grant of Experimental Wireless Licence
(THIS IS NOT A LICENCE)
Sir,
With reference to your application on reverse, this Ministry agrees in principle to grant
you an Experimental Wireless Licence for the purpose ……………………………………..
…………………………………under conditions and parameters given below :Frequency (ies)
Emission
R.F. Power Output
Hrs.of Operation
Remarks
2. It is necessary that siting of proposed fixed stations(s) (item 8 of application) should be
cleared by the Standing Advisory Committee on Radio Frequency Allocation (SACFA), as
per instructions enclosed.
3. The licence will be issued after you have obtained siting clearance as indicated above and
payment of Rs.100/- as licence fee, in the form of crossed bank draft obtained from any
branch of State Bank of India and drawn in favour of the “Pay & Accounts Officer
(Headquarter) Department of Telecommunications”, New Delhi, payable at State Bank of
India, New Delhi Main Branch (Parliament Street) (Code No.0691) or Service Branch, New
Delhi (Code No.7687).
Yours faithfully,
(
)
Assistant Wireless Adviser to the
Government of India
(To be submitted on separate sheet of paper, in quadruplicate)
ANNEXURE A
1. Name & Address of the applicant
:
2. Purpose for which licence is required
:
3. Location of wireless equipment/station
4. Equipment proposed to be
used/developed.
5. R.F. Power output
6. Frequency (ies) or Frequency band
desired
7. Type of emission
8. Proposed hours of operation
9. Particulars of foreign nationals.
If any, who will operate the wireless
equipment. (Name, Nationality,
Home address, passport & visa No with
date of validity etc)
:
:
Experimental-Radiating/Non-radiating
i)
Design, development & testing
ii)
Research & Experimentation
iii)
Training/Imparting instructions to
students
iv)
Servicing, maintenance and testing
of equipment
v)
(Delete whichever is not applicable)
:
:
:
:
From………
to ………
ANNEXURE B
PERSONAL PARTICULARS OF OWNER/MANAGING DIRECTOR/EXECUTIVE
DIRECTOR
1. Name in full
:
2. Father’s name
:
3. Designation
:
4. Nationality
:
5. Date of birth
:
6. Place of birth
:
7. Permanent address
:
8. Present address
:
9.
Passport No., if any
: