Form A (Multiple Stations/Equipment) : Republic of The Philippines

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Republic of the Philippines Form No.

NTC 1-05
NATIONAL TELECOMMUNICATIONS COMMISSION Revision No. 01
Revision Date 03/31/2021
BIR Road, East Triangle, Diliman, Quezon City

FORM A (MULTIPLE STATIONS/EQUIPMENT)

APPLICANT

PARTICULARS
Indicate "N/A" for items not applicable.
Radio Equipment Make Type/Model Serial Number Power Output

Signature over Printed Name of Applicant /


Duly Authorized Signatory/Representative

Date Accomplished

THIS FORM IS NOT FOR SALE AND CAN BE REPRODUCED

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