APPLICATION FOR RTR(A) License: Radio Telephony License (AeronautJcal)

License
Application ID. RTR020120240109105

General Information

1. Authorized Person Details

Authorized Person Name Abhlshek Panda

Authorized Person Designation

Address Flat no-202. Sri Sal Towers. Vlshal nagar colony, Hydershahkote,
Pincode 500091
District Hyderabad

State TELANGANA
Landline No

Fax

Mobile No 9100140209
Email abhishekpanda99@gmail.com

2. Personal Details

Name Abhishek Panda

Father/Mother/Husband Name Jitendra Kumar Panda

Date of Birth 11-12-1998

Place of Birth Odisha

Height 179 Cms

Color of Eyes black

Color of Hair black

Qualification 10+2

Complexion wheatish

Occupation Student

Marks of Identification mole near right eye

Nationality Indian

Passport No

Date of passport Issue

Date of passport expiry

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 Place where Passport Issued

Father's Home Address

Visa Number

Visa Type

Visa Issued Date

Visa Validity Date

Visa Issued By

Foreign Town

Period of Stay in Inda

Country of Visit

Present Address Flat no- 206, Fort View Edifice, Hydershahkote

,Hyderabad ,TELANGANA -500091
Pennanent Address Flat n0- 202, Sri Sai Towers, Vishal Nagar Colony,
Hydershahkote ,Hyderabad ,TELANGANA -500091
Year of Exam 2023
Month of Exam October
Center of Exam Hyderabad

3. Previous License Details

Nil

4. License Fee Payment Details

License Validity: Life time

NTRP 0901240055003 20157909012400054 09-01-2024 10000.00

826

Scanned copy of Payment Transaction Receipt attached

5.Declaration

I hereby solemnly declare and say that foregoing facts are true and correct and nothing is false there in and no material has
been concealed therefrom. I also agree that in case any information given by me herein before is found false at a later date, the
licence, if granted, will be cancelled.

I further solemnly given an undertaking that the apparatus described here-in-before will be worked in accordance with the
conditions of the licence and operators holding approval certificate of proficiency shall only be employed to work the said

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apparatus

I have carefully read and understood the ruJes contained in the Indian Wireless Telegraphy (CommerciaJ Radio Operators
Certificates of Proficiency and license to operate Wireless Telegraphy) Ru.Jes, 1954 and undertake to abide ~ ,

Signatu~~he applicant

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