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Telecommunication Act – 2001

(Act 2001-36)

FORM 39

(Regulation 3 (a)) TU039

IMPORTANT INFORMATION

1. Applicant is required to submit photocopies of the following documents with this application:

(a) Passport (for foreigners).

(b) Current amateur station licence (if any).

(d) Letter from the owner of the premises approving the installation of amateur radio antenna. (For premises which are not owned by the applicant.)

(e) Schematic diagrams of the proposed antenna installation (if any).

2. All amateur equipment have to be approved by the Ministry.

3. Payment for the Telecommunications Licence fees may be made by cheque.

APPLICATION FOR AMATEUR RADIO LICENCE

PART A: APPLICANT INFORMATION

1. Name of Applicant (as in Passport)

2. Address of Applicant (Home)

3. Date of Birth

4. Arrival Date

5. Nationality

6. Telephone No.

7. Facsimile No.

8. Pager No.

9. “E-mail” Address

10. Is application submitted with Cheque

Yes

If under 18 Years

Full Name of Parent or Guardian

Address

Relationship (if any) to applicant

Name of Current Employer

Occupation/Designator

Amateur Operator’s Qualification

Certificate Number

Application Information

Type of Licence

General Class

Mobile/Portable

Station Information

Location

Address

Antenna Electrical Characteristic

Choice Call-Sign

Do you prefer a choice call-sign

Yes

If yes please indicate your preferred call-sign in the following format where XX is from AA to ZZ

1st Choice - 8P6XX

1st Choice_1

1st Choice_2

2nd Choice - 8P6XX

2nd Choice_1

2nd Choice_2

Note: Applicant is required to enclose a payment of $25.00 for the choice call-sign together with this application. The approval will be subject to the following conditions:

• Only licensed radio amateurs shall be allowed to apply for a call-sign under the choice call-sign scheme. The call-sign cannot be applied in advance and kept unused.

• Each radio amateur shall be allocated only one call-sign. Submission of multiple applications will not be accepted.

• The call-sign allocated under the choice call-sign scheme shall not be transferable.

• The call-sign shall be withdrawn if the amateur ceases to hold a valid amateur radio station licence.

Radio Equipment Information

Manufacturer

Model

Emission

Transmitter Output Power

Serial No.

Frequency Bands

VHF/HF

Manufacturer

Model

Emission

VHF/HF

Transmitter Output Power

Serial No.

Operating Frequency

Lass Pass Filter

Manufacturer

Model

Attenuation

Other equipment

Manufacturer

Model

Emission

Other equipment

Transmitter Output Power

Serial No.

Frequency Band

We declare that we have not commenced provision or operation of any of the telecommunication stations or networks applied for in this application and all the information in this application form is true and correct. We understand that approval from the Ministry responsible for Telecommunications in Barbados for this application is based on information as declared in this application. We further acknowledge that, should any of the information declared herein be found to be untrue, inaccurate or incorrect, any licence granted by the Ministry will be rendered null and void. The Ministry reserves its right to impose penal sanctions against us under any applicable laws and regulations in force and this is without prejudice to any civil remedies that the Ministry has against us if any information declared in the application be found to be untrue, inaccurate or incorrect.

I have been given a copy of the Amateur Radio Handbook.

Name/Signature

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.