Republic of the Philippines

Form No. NTC 1-06

NATIONAL TELECOMMUNICATIONS COMMISSION Revision No. 01
BIR Road, East Triangle, Diliman, Quezon City Revision Date 03/31/2021

FORM B (FOR MODIFICATION)

APPLICANT

PARTICULARS
Indicate "N/A" for items not applicable.
STATION Authorized Proposed
LOCATION

LONGITUDE
LATITUDE
POINTS OF COMM/SERVICE AREA

ASSIGNGED FREQ.
BW & EMISSION
CONFIGURATION
DATA RATE
EQUIPMENT
MAKE/TYPE/MODEL
SERIAL NO.
POWER OUTPUT
FREQ. RANGE
OTHERS

Signature over Printed Name of Applicant /

Duly Authorized Signatory/Representative

Date Accomplished

THIS FORM IS NOT FOR SALE AND CAN BE REPRODUCED