REPUBLIC OF NAMIBIA
NAMIBIAN COMMUNICATIONS COMMISSION
APPLICATION FOR AN AMATEUR RADIO GUEST LICENCE
(The form must be completed in capital letters)
1. SURNAME (MR/MRS/MISS)
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2. FIRST NAMES IN FULL
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3. PLACE (TOWN AND COUNTRY) AND DATE OF BIRTH
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4. CONTACT ADDRESS IN NAMIBIA
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5. CLASS AND CALL SIGN OF LICENCE HELD
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6. CERTIFIED PHOTO COPY OF VALID AMATEUR RADIO LICENCE MUST ACCOMPANY THIS APPLICATION FORM
7. PERIOD OF VISIT TO NAMIBIA (STATE DATES)
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8. DETAILS OF ITINERARY
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9. PLEASE RETURN APPLICATION FORM AT LEAST FIVE (5) WEEKS BEFORE LICENCE REQUIRED TO :
NAMIBIAN COMMUNICATIONS COMMISSION, PRIVATE BAG 13309, WINDHOEK
10. LICENCE FEE : N$50,00 WITH APPLICATION.
DATE _____________________________________________________________
SIGNATURE _________________________________________________________