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					                                                                                          TRC/SM/MM/RFA_1

                TELECOMMUNICATIONS REGULATORY COMMISSION OF SRI LANKA
     APPLICATION FORM FOR THE ISSUE/RENEWAL OF USE OF FREQUENCY /FREQUENCY
       EMITTING APPARATUS FOR MARITIME MOBILE SERVICE (MARITIME MOBILE /
                     SHORE STATION/DEMONSTRATION STATION)
                (Please read the General Instruction before completing this application form)

                                                                                File No: ……………………
General Details :

1.      Name of the Applicant (in full) :
        …………………………………………………………………………………………………………………
        …………………………………………………………………………………………………………………
2.      Registered /Business Address:
        …………………………………………………………………………………………………………………
        …………………………………………………………………………………………………………………
3.      Address of Communication (If different from 2 above):
        …………………………………………………………………………………………………………………
        …………………………………………………………………………………………………………………
4.      Business or Company Registration No/ Passport or NIC No (if applicable) :
        …………………………………………………………………………………………………………………
        …………………………………………………………………………………………………………………
5.      Contact Numbers Tel :  Fax :
                             Email :
6.      Nature of Business :
        …………………………………………………………………………………………………………………
        …………………………………………………………………………………………………………………
7.      The purpose of Use:
        …………………………………………………………………………………………………………………
        …………………………………………………………………………………………………………………
        (Please give a description of the project and the use of the radio communication equipment)

8.      Expected period of Use:
        From :………………………………                            To: ……………………………….

9.      (i)     Name of the Contact person :
                …………………………………………………………………………………………………………
                …………………………………………………………………………………………………………

        (ii)    Designation : …………………………………………………………………………………………

        (iii)   NIC/Passport No : …………………………………………………………………………………...

        (iv)    Contact Numbers :       Tel:                                    Mobile:

                                        Email :

(Please give details of a responsible person of your organization. This is for purpose of obtaining
technical /operational information and any other requirement of the Commission such as renewals, sealing etc.)

                                                                                                         1
  Technical Details:

  10.      Radio Frequency Band : VLF/LF/MF/HF/VHF/UHF/SHF/EHF

  11.      Class of Station : Fixed / Land Mobile/ Maritime Mobile / Aeronautical Mobile/Broadcasting / Others

  12.      Requested Frequency Range/Frequencies of Operation:
           …………………………………………………………………………………………………………………
           …………………………………………………………………………………………………………………

  13.      Number of Frequencies Required:
           …………………………………………………………………………………………………………………

  14.      Date of Commencement of Service If Existing:
           …………………………………………………………………………………………………………………

  15.      Details of the Equipment (Please fill the attached Annexure.)

  16.      Name & Address of the Manufacture of Equipment:
           …………………………………………………………………………………………………………………
           …………………………………………………………………………………………………………………

  17.      Name & Address of the Local Vendor from whom the equipment will be purchased:
           …………………………………………………………………………………………………………………
           …………………………………………………………………………………………………………………



I / We declare that all the details given in this application form are true and correct and I/We hereby undertake to
inform Telecommunications Regulatory Commission of Sri Lanka, immediately , of any changes to the details given
in the application form or any documents submitted herewith.




  Date :                   ……………………………………                                          ……………………………..
                              Signature                                               Signature



  Seal                     ……………………………………                                          ……………………………..
                              Name                                                    Name




                                                                                                                   2
General Instructions :

      If the applicant is a Limited Liability Company, it is required to submit certified copies of form
       48,36 ,Memorandum of Association and Articles of Association, Certificate of Incorporation. This
       is required to be submitted by the new applicants and only if there is any change in the documents
       already submitted.

      If the applicant is an individual, it is required to submit a copy of the passport or NIC.


      If the applicant is a firm, Business Name Registration Certificate should be submitted.
       For a partnership the names of all the Partners should be submitted with the application form.

      You are required to submit followings with your application

              (i)     Technical specifications of the equipment.
              (ii)    Invoice relevant with the importation of the equipment.
              (iii)   If the equipment imported for Sri Lankan Registered Boat/Vessel, Registration
                      Certificate of the Boat/Vessel.
              (iv)    If the equipment imported for Boat/Vessel manufactured for foreign export, proof
                      documents of export order.
              (v)     Frequency Confirmation Letter from the Manufacture/Local Agent(Apply only for
                      local use)

        Followings required only for Fishing Boats

              (i)     Permission Letter from the Ministry of Fisheries and Ocean Resources is required if
                      the frequencies allocated them to be used.
              (ii)    Details of membership of Fisheries Society or Association in the relevant area.
              (iii)   Assurance from the owner that ownership of vessel and the equipment will not be
                      transferred without prior approval of Ministry of Defence.


      You may be required to furnish more information in order to the process the application.

      The Commission may any time refuse the application or cancel and revoke the license issued, if the
       applicant has submitted to the Commission misleading and false information.

      Original with three (3) copies of all documents.
3
           MARITIME SERVICE (MARITIME MOBILE/SHORE STATION/DEMONSTRATION STATION)


                                 Location Details                                                      Equipment Details                                                       Antenna Details
No    Location            Geographical
     (Address of          Co-ordinates
     Registration                              Area     Height     Call   Type of   Make    Serial   Power   Channel       Necessary    Class     Frequenc   Make    Type   Gain    Polarization   Azimuth    Heig    Quantity
      No. of the      Latitude   Longitude    Radius    Above                                                                B.W         of
                                                                   Sign   Station    &       No.      (W)    Spacing                                  y       &             (dBi)                               ht
     Vehicle/Boat                              (km)      Mean                                                                KHz       Emission
                                                                                    Model                                                          (MHz)     Model          (dBd)                             abov
                                                       Sea Level
                                                          (m)                                                                                                                                                 e sea
                                                                                                                                                  TX   RX                                                     level
                                                                                                                                                                                                               (m)




                                                                                                                                                                                                             ANNEXTURE

                    Note : 1. If this space is not sufficient ,please use extra paper to indicate all stations.
                           2. Equipment Type should indicate whether the equipment is Main, Emergency, Survival Craft VHF or any Others.

				
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posted:8/17/2012
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