1. Administrative details: a) b) c) d) e) 2. Name of the organisation(or individual)……….......................................................................... Nationality………………….ID/PP No………………………..……………. Postal address..............................................…….................…….................... Business Telephone............................. Fax..…..………...................…........... Physical Location: Road/Street………....Building…………LR No…..……. Name and postal address of the local supplier (if any)........................…....... Postal address...........................………........................................................... Business Telephone.................................... Fax........................................... Type of radio communication service service:………………………………………………. • HF • MF • FM (delete as appropriate) Authorised broadcast area(s)………………………………………………… (attach certified copy of broadcasting permit) Name of person / organisation responsible for payment of bills....................................... ............................................……....................... Transmit Site Details: i) ii) iii) iv) v) vi) 3. Name........................................................................... Land registration number. ..................................................... Road/Area .........................................................................…... Geographical co-ordinates: Latitude : Degrees..........Minutes ..….......Seconds ............ (N/S) Longitude : Degrees....…..Minutes .….........Seconds .....…….(E) Altitude above sea level (in metres).....……….......................…….. Relative height around 15 kilometre radius ....…............................... Transmitter Equipment Details: a) Equipment and performance characteristics. i) Name ...................................................................................... Model .............……….......….................................................. Serial number ........………..................................................... ii) Carrier output power............………....................................... iii) Effective Radiated Power (dBW) ..………............................. iv) Transmission system (applicable to FM systems only) : …………………….. • System 1: Monophonic, max deviation +/−75 kHz • System 2: Monophonic, max deviation +/−50 kHz • System 3: Stereophonic ,polar modulation, max deviation +/−50 kHz • System 4: Stereophonic, pilot tone system , max deviation +/−75 kHz 83