<p>Annex 5 Frequency Clearance of a Node or Mailbox Port or Notice of Variation for a Mailbox</p><p>ALL of the following information is required to process your application. Fill in this form by hand after reading the guidelines on page 5.</p><p>Callsign Requested______and some alternatives if your first choice isn't available ______</p><p>New Proposal / Change of Site / New Channel / Change of Equipment or Antenna Details</p><p>Type of Station: Packet Node / Packet Mailbox / Regenerative Node</p><p>Use: AX25 / TCPIP / DX CLUSTER / UNCONNECTED PACKET</p><p>Location of station _____ km ______of ______(Give distance in km and bearing from the nearest large town) Address of Station______(inc Postcode) ______</p><p>______</p><p>National Grid Two Letter & Six Figure Reference: ______</p><p>IARU QTH Locator: ______</p><p>Heights Base of Mast above Mean Sea Level (MSL) _____ metres.</p><p>Highest point of Antenna System above ground ____ metres.</p><p>Number of Masts to be used _____ Equipment Details: Port 1 Port 2 Port 3 Port 4 TX RX Packet Baud Rate Antenna Details Type of Antenna: Gain of Antenna: dBd Direction of max Degrees radiation: E of North Polarisation TX Power Details Peak Power fed to dBW antenna (PX) Peak effective radiated dBW power (PXe) Port Usage: User or Link Linking To: Primary TX frequency MHz Secondary TX frequency MHz Primary RX frequency MHz Secondary RX frequency MHz Note: If your Node/Mailbox has greater than 4 radio ports, then please use another copy of this page.</p><p>Applicants Name: ______Callsign: ______</p><p>Applicants Telephone No. ______Applicants Address: ______</p><p>______</p><p>______</p><p>Postcode ______</p><p>Note: This is the address were all correspondence will be sent to, the address is not published.</p><p>Applicants Packet BBS: ______</p><p>Applicants Email Address: ______</p><p>Site Detail: Is the aerial site to be shared with an existing user? If yes, give details including frequencies: EMERGENCY CLOSE-DOWN PROCEDURE For all applications, it is necessary to describe in detail how the station will be closed down in the event of a request from Ofcom or RSGB to operate the emergency close-down procedure.</p><p>STATE THE CLOSE-DOWN PROCEDURE BELOW a) how the close-down operators will travel to the site? b) how they will gain access to the site? c) how they will physically shut off the station? d) the location of the equipment and its switch off controls? e) Only (insert one name/callsign)...... is authorised to restore power to the station following a request to shutdown the station.</p><p>Names, Callsigns, Telephone Numbers And Travelling Times Of Close-Down Operators(from work/home or both) NB Minimum of 3 closedown operators to be available at all times (30 minutes max travel time - please note if 24 hours) Name Callsign Travel Time Telephone Numbers (Minutes) 1 h h 1 w w 2 h h 2 w w 3 h h 3 w w 4 h h 4 w w 5 h h 5 w w DISTANCES AND AVAILABILITY OF CLOSEDOWN OPERATORS</p><p>Please give the location of the closedown operator, the distance to be travelled and the percentage availability (under normal circumstances) at the telephone number listed. For example if the person listed is a mobile service engineer who is only in the office for 50% of the time then the percentage availability is 50%.</p><p>Operator Location Distance % Availability (km) 1 (Home) 1 (Work) 2 (Home) 2 (Work) 3 (Home) 3 (Work) 4 (Home) 4 (Work) 5 (Home) 5 (Work) Application for Frequency Clearance</p><p>DECLARATION</p><p>I accept that RSGB will provide insurance cover for third party liability of the node or mailbox installation.</p><p>I acknowledge that OFCOM or RSGB may request the node to be closed down at any time, and will comply within 30 minutes of receiving such a request.</p><p>I accept the responsibilities of node manager or mailbox Sysop as outlined in this document.</p><p>I will ensure that the station is operated only under the conditions shown in the application form and will notify the RSGB of any changes.</p><p>I will notify RSGB IMMEDIATELY of any changes to the closedown list.</p><p>I hold a current, valid UK amateur licence, callsign ______</p><p>The above information is correct to the best of my belief.</p><p>I agree to the above conditions.</p><p>Signature</p><p>Name:</p><p>Address:</p><p>Tel. Number:</p><p>Email Address:</p><p>Date:</p><p>Now send your applications to: RSGB HQ AR Dept, 3 Abbey Court, Fraser Road, Priory Business Park, Bedford MK44 3WH and keep a copy for yourself. </p>