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

Physical Address : 6th Floor, Moposo House, Kingsway Road, Maseru Tel. + 26622326784

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)

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 Do you hold any other licence issued by the Authority ?__________________________________

If yes : what type of licence ____________________________________________________________

Licence Number and date of issue _______________________________________________________

1.8  Category of licence required:   Restricted    □                               General       □

1.9  Desired call sign  _______________________________________________________________

2.  EQUIPMENT AND TYPE 

MANUFACTURER _______________________________________________________________

MODEL  ________________________________________________________________________

  POWER  (W)               PEAK ENVELOPE                TYPE OF EMISSION  

___________                 ________________                 ___________________         
	
3. ANTENNA PARTICULARS
a.	Gain (db) ___________________________________________________________

b.	Mast height above ground (m) ___________________________________________

c.	Polarization __________________________________________________________

d.	Radiation pattern ______________________________________________________

e.	Azimuth _____________________________________________________________

f.	Elevation (degrees) _____________________________________________________

g.	Beam with (degrees) ____________________________________________________

h.	ITU-R antenna ref ______________________________________________________

	
4 OTHER INFORMATION
Attach certified copies of other amateur licences issued by other countries	

5.  ACKNOWLEDGEMENT

6.1 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.

6.2	The applicant undertakes to adhere to the terms and conditions of the licence as the Authority may prescribe.

Signature ______________________________________________________________

Full names of signatory  __________________________________________________
                                                                  Name of applicant