LESOTHO COMMUNICATIONS AUTHORITY	
           
Application for Airport Radio Station Licence
Rule 59 of the LTA Rules of Practice, Procedure and Service Provision

Physical Address : 6th Floor, Moposo House, Kings way Road, Maseru

Postal Address: LTA, P.O.  Box 15896, Maseru 100 Fax + 26622310984 e-mail lta@lta.org.ls  	
a)	In terms of rule 66(1), an application for the allocation of frequency, frequency bands and 
co-ordination of radio frequency spectrum may be made by submitting to the Authority a properly completed form.
b)	Any information requested in this form may, of lengthy, be contained in an appendix.	
1.    PARTICULARS OF AN APPLICANT

1.1	PERSONAL PARTICULARS

Full Name of an applicant  ___________________________________________________________

_________________________________________________________________________________

Physical Address  __________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Postal Address ____________________________________________________________________

________________________________________________________________________________

Telephone Number  _______________________________________________________________

Telefax  ________________________________________________________________________

e-mail  __________________________________________________________________________

1.2  State legal form of applicant e.g. company, trust, other ________________________________
(attach copy of memorandum of articles of association, constitution or founding document certified by two office-bearers of the body, certified passport copy of the director/applicant)

1.3  If registered, office of registration _________________________________________________

1.4  Registration No _______________________________________________________________

1.5  Date of registration  ____________________________________________________________

1.6  Purpose for which the proposed communication is required _____________________________

_________________________________________________________________________________

1.7 Particulars of technical capability ___________________________________________________

1.8 Nature of activity of Organisation ___________________________________________________

1.9 Do you hold any other licence issued by the Authority ___________________________________

If yes : what type of licence ___________________________________________________________

Licence Number and date of issue ______________________________________________________	

2.  LOCATION OF AIRPORT

___________________________________________________________________________________

CALL SIGN
	
3. CATEGORY OF PROPOSED EQUIPMENT

A. Communication/Navigation Aids

MF	
HF	
VHF	
UHF	
VOR	
VHF
Beacon	
SSR	

	

	

PAR	
MLS	
ILS	
NDB	
OTHER	

	

	

Please attach copies of specifications of the proposed equipment

B.	Operating Parameters

Category	
Make & Type	
Frequency (MHz/KHz)	
Bandwidth	
Type of emission	
RF Power  Output (W)	

MF	

	

HF	

	

VHF	

	

UHF	

	

OTHER	

	

	
CLASS 
 COMMERCIAL FREIGHT (CF)  □   (PF) PRIVATE FREIGHT □   
 COMMERCIAL PASSANGER (CP)  □     PRIVATE LEISURE (PL) □   

CERTIFICATE TYPE    
GENERAL RADIOTELEGRAPHY CERTIFICATE  GC □   
RESTRICTED RADIOTELEPHONE (AERONAUTICAL) RA □   
RESTRICTED RADIOTELEPHONY (MARITIME)  RM □   
RADIO OPERATOR GENERAL CERTIFICATE  RO  □ 
SPECIAL TELEPHONE ST □   	

4.  ACKNOWLEDGEMENT

4.1 The applicant acknowledges the statements in this form and accompanying documents will be relied upon by the Authority, and confirms that to the knowledge and belief of the applicant all such statements are true and correct.

4.2	The applicant undertakes to operate the equipment with a licence. 

4.3	The applicant undertakes to adhere to the terms and conditions of the licence as the Authority may prescribe, the LTA Act 2000 and the applicable Radio Regulations.

________________________________________________________________________________
Signature                                                                                                      Date
Full names of signatory  ____________________________________________________________
                                                                   Name of applicant