Please note: This form should be printed out and sent via 'surface mail' to the address given below. Please print entire document.
For guidance see information sheet RA46.
A licence can only be issued to a legal entity. The Agency recognises the following: Individual or Sole Trader, Partnership, Public Limited Company, Limited Company or Incorporated Association.
For a partnership, give the full name of one partner (this partner must also sign the declaration) and supply a list of the full names of all other partners at the declaration.
For example Corporation/Local Authority, Registered Charity etc.
The callsign must not be more than twelve characters and must not be a place name. A callsign is a requirement of operation under the terms of the licence.
Yes No
14
What is the national grid reference (NGR) of this location?
Two letters followed by six figures, eg NJ 935 044, one letter and six figures in Northern Ireland (obtainable from an Ordnance Survey Map).
Watts
Omni-directional antenna Downtilt antenna Downfire antenna Radiating cable Directional antenna
Yes - please complete Q20-26 No - go to Q27
Address
Landline Landline and microwave Dial up landline Microwave only Reverse Frequency Working (RFW)
What type of directional antenna would you like to use for the RFW control point? The frequency band used and operational conditions would normally dictate which antenna is used.
3 element 4 element 6 element 8 element omni-directional
Please enclose a power of attorney A power of attorney is a written authority given by one person to another to act on their behalf in their absence.
I declare that all the details given in this application form are correct to the best of my knowledge.
Partnerships must be applied for by one partner signing "For self and partners". A director or authorised person must sign for Public Limited Companies, Limited Companies and other legal entities.
If the number of partners exceeds the space provided above, additional partners details should be provided on a separate sheet of paper in the format given above and attached to this form.
Failure to complete this form fully or provide any additional information requested, may result in a delay to the processing of your application.
Where to send your form
Details of where to send your form and the fee payable are enclosed on the separately inserted information sheet RA 123. If the sheet is missing or you are unsure where to send your form contact the Agency's Enquiry Point on 020 7211 0211.
If you require any advice on completing this form please contact your Agency Local Office. Details of Local Offices' areas of responsibility can be found on RA123.
It can be helpful for your radio supplier to be notified of the frequency assignment made to you. Complete the following if you would like a copy of your licence and schedules to be sent to your supplier.
Please find enclosed a copy of your customer's licence schedule as requested on the RA30 application form
Radiocommunications Agency