REPUBLIC OF THE PHILIPPINESDepartment of Transportation and CommunicationsNATIONAL TELECOMMUNICATIONS COMMISSIONQuezon CityAPPLICATION FOR AMATEUR RADIO OPERATORS' EXAMINATIONCheck CLASS of examination being applied for:[] Class "A" Elements 8, 9 & 10 (Element 1 - Code) 1 x1[] Class "B" Elements 5, 6 & 7picture[] Class "C" Elements 2, 3 & 4[] Class "D" Element 2 OnlyPlace of Exam Date of ExamAPPLICANTPRINT (last name) (first name) (middle name)MAILING ADDRESS Tel. Nos. DATE OF BIRTH Place of BirthCITIZENSHIP AGE Civil Status: (Married/Single)Latest Amateur Radio Examination Taken (For Re-examination):State Class, Date and Place of Examination:Applicant is:[] Holder of valid First Class Radiotelephone/Radiotelegraph Operator Certificate[] Registered Electronics and Communications Engineer[] Holder of Amateur Operator Certificate (Class)Copy this in your costumary handwriting:"This is to certify that I have read and understood the instruction in this application form"SIGNATURE OF APPLICANTRequirements to be submitted:New Applicant Removal/Re-examination Upgrading1.Copy of Birth Certificate, Baptismal Cert., 1. Copy of Report of Rating of previous 1.Authenticated copy of Amateur RadioPassport, PRC License, Driver's License orexamination taken.Station License. any document which can serve as a basis for 2. Two (2) identical copies 1"x1" picture. 2. Two (2) identical copies 1"x1" picture age and Filipino citizenship. 3. Two (2) self-addressed stamped 3. Two (2) self-addressed stamped2. Proof of Attendance in a seminar envelopes.envelopes. conducted by an NTC accredited amateur4. P50.00 Examination Fee 4. P50.00 Examination Fee. club. NOTE:3. Two (2) identical copies 1"x1" picture. New applicants who are graduates of BSECE or Holder of 1RTG/2RTG/1PHN4. Two (2) self-addressed stamped envelopes must present their license/certificate to be qualified to take Class "B"5. P50.00 Examination Fee examination directly.TO: THE CHAIRMAN, Radio Operators Examination CommitteePLEASE ADMIT Mr/Ms.with mailing address atin the amateur radio operator examination indicated below:[] Class "A" Elements 8, 9 & 10 (Element 1 - Code)1" x 1" Picture[] Class "B" Elements 5, 6 & 7[] Class "C" Elements 2, 3 & 4[] Class "D" Element 2 OnlyNOTES: 1. Examination starts at 8:00 AM or as designated two days before the date of examination2. Examinees late for more than 30 minutes will be considered absent.3. Request for re-schedule of examination must be filed at least 1 week before the date of examinationDate of Exam: Place of Exam:GLENN ANTHONY C. MERCADOChief, Safety Radio Services& STCW Compliance Division