REPUBLIC OF THE PHILIPPINES

Department of Transportation and Communications

NATIONAL TELECOMMUNICATIONS COMMISSION
Quezon City

APPLICATION FOR AMATEUR RADIO OPERATORS' EXAMINATION

Check CLASS of examination being applied for:
[

Class "A" Elements 8, 9 & 10 (Element 1 - Code)

Class "B" Elements 5, 6 & 7

Class "C" Elements 2, 3 & 4

Class "D" Element 2 Only

Place of Exam

1x 1
picture

Date of Exam

APPLICANT
PRINT

(last name)

(first name)

(middle name)

MAILING ADDRESS
Tel. Nos.
DATE OF BIRTH
Place of Birth
CITIZENSHIP
AGE
Civil Status:
Latest Amateur Radio Examination Taken (For Re-examination):
State Class, Date and Place of Examination:

(Married/Single)

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 APPLICANT
Requirements to be submitted:
New Applicant

Removal/Re-examination

1. Copy of Birth Certificate, Baptismal Cert.,

Passport, PRC License, Driver's License or

1. Copy of Report of Rating of previous

examination taken.

Upgrading
1. Authenticated copy of Amateur Radio
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 stamped

2. Proof of Attendance in a seminar

envelopes.

conducted by an NTC accredited amateur

club.

envelopes.

4. P50.00 Examination Fee

4. P50.00 Examination Fee.

NOTE:

3. Two (2) identical copies 1"x1" picture.

New applicants who are graduates of BSECE or Holder of 1RTG/2RTG/1PHN

4. 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 Committee

PLEASE ADMIT Mr/Ms.
with mailing address at
in the amateur radio operator examination indicated below:
[

Class "A" Elements 8, 9 & 10 (Element 1 - Code)

Class "B" Elements 5, 6 & 7

Class "C" Elements 2, 3 & 4

Class "D" Element 2 Only

1" x 1" Picture

NOTES:
1. Examination starts at 8:00 AM or as designated two days before the date of examination
2. 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 examination

Date of Exam:

Place of Exam:

GLENN ANTHONY C. MERCADO

Chief, Safety Radio Services
& STCW Compliance Division