Republic of the Philippines s15

Republic of the Philippines Department of Information and Communications Technology NATIONAL TELECOMMUNICATIONS COMMISSION Regional Office No. VII

APPLICATION FOR RADIO OPERATOR’S EXAMINATION 1 X 1 Check type of examination being applied for : ID Picture ( ) RROC-Ship Low Power El. 1 2 ( ) PHN : El. 1 2 3 4 ( ) RMAP ( ) RTG : EL. 1 2 3 CODE ( ) Others : ______

Place of Exam : ______Date of Exam : ______APPLICANT : ______(last name) (first name) (middle name) MAILING ADDRESS : ______Tel. No. : ______Date of Birth : ______AGE : ______Place of Birth : ______Citizenship ______SCHOOL ATTENDED : ______COURSE TAKEN : ______YEAR GRADUATED ______TRAINING CENTER ATTENDED (for GOC) ______

“ WILLFUL FALSE STATEMENTS AND SUBMISSION OF FAKE Cashier’s Stamp : DOCUMENTS MADE IN THIS APPLICATION WILL AUTOMATICALLY DISQUALIFY APPLICANT TO TAKE THE EXAMINATION”

______SIGNATURE OF APPLICANT Requirements to be submitted : Records Verification RROC-SHIP LOW POWER FOR REMOVAL : Copy of result of rating of the last examination  Copy of PRC certificate/ID 2 (two) pcs. 1 X 1 ID picture  2 (two) pcs. 1 X 1 ID picture 1 pc. Mailing envelope w/ stamp  2 (two) mailing envelopes (w/stamp)

PHN / RTG RMAP-AIRCRAFT  Pilot License or student pilot license  Copy of Transcript of Records with S.O.  3 (three) pcs. ID picture & mailing envelop  3 (three pcs. 1 X 1 ID picture  2 (two) mailing envelope w/ stamp UPGRADING PHN / RTG  Copy of Birth Certificate  Photo copy of ROC Name and Signature  3 (three pcs. ID pictures & mailing envelop

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TO : THE CHAIRMAN, Radio Operators Examination Committee

PLEASE ADMIT Mr./Ms. ______1 x 1 With mailing address at ______ID picture In the class/type and date of examination indicated below : ( ) RROC-Ship Low Power : El. 1 2 ( ) PHN : El. 1 2 3 4 ( ) RMAP ( ) RTG : EL. 1 2 3 CODE ( ) OTHERS ______El. 1 2 3 4 CODE NOTES : 1. examination starts at 8:00 AM or as designated two days before the date of examination 2. Examinees late for more than 30 minutes will be considered absent. 3. Request for re-schedule of examination must be filed at least 1 week before the date of examination

Date of Exam : ______Place of Exam: ______

JESUS M. LAURENO, PECE Regional Director