Application For Radio Station License

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Republic of the philippines

NATIONAL TELECOMMUNICATIONS COMMISSION


NTC Bldg., BIR Road, East Triangle, Ditiman, euezon
City

BROADCAST SERViCE DEPARTMENT


DATE

APPLICATION FOR t ] NEW [ ] RENEWAL RADIO STATION LICENSE

1. Applicant
2.
a
J. If radio franchise grantee, state RA No
and state of approval
4. If granted a Temporary Permit to operate a radio station,
state of approval of said permit

5. Exact location of station


6. Radio station license number to be renewed
Call-sign Expiration date
1. If new station, state Construction permit No
Expiration date
Call-sign
B. Effective Radiated power
Gain Bay
9. Name of Oper:ators Class & License No. Expiration Date

-
I HEREBY DECLARE UNDER THE PENALTIES OF PEUURY THAT THE FOREGOING
ARE TRUE AND CORRECT TO THE BEST STATEMENT MADE BY ME
OF MY KNOWLEDGE AND BELIEF.

Res, Cert. No,


Issued on
Issued at APPLICANT
(Signature over printed name)
TIN

1. This application should be submitted in DUpUCATE.


2.
ir apprication is ror RENEWAL or pHorosrAr/xERox
ffiX'*"*"?T:J:f: ffJJS:Sii?,il#ffoyo*tt copy ir
3. Attached oRIGINAL
coPY oF RADIo srATIoN CONSTRUCTION
PERMIT if apptication is for NEW RADI9
UCENSE. sTATioN
4. In case of changes in the composition
of the governing body of the firm from originally
copy of the document indicating such submitted, an authenticated
change sfioub ats6 oe ilurnitt a with this
5, Payment of the required reels-; application.
snouu ue'maoe either in cnii o, in cASHlERlil"rnrvacrn,s
.HECK drawn in any
I#:#ilil1,f^-BilAt%^?,HrTJil out or town) enJoouJ in any Metro Manira bank in ravor or NATT'NAL

WARNING
WILLFUL FALSE STATEMENTS MADE
ON THiS APPLICATION ARE PUNISHABLE
THE REVISED PENAL CODE BY A MAXIMUM UNDER ARTICLE 183 OF
IMPRISONMENT Oi SIX
TOI YEARS

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