Republic of the Philippines

Office of the President

NATIONAL TELECOMMUNICATIONS COMMISSION
Regional Office No. IV

1. NAME OF COMPANY :
2. ADDRESS :
Tel. No.
3. CLASS OF STATION (Check appropriate box)
Fixed

Land Base

Repeater

Others

4. NATURE OF SERVICE (Check appropriate box)

CV station open exclusively for correspondence of a private agency
CP station open to public correspondence
CO station open exclusively for official correspondence (Government Agency)
5. LOCATION OF RADIO STATION (Complete Address)

6. GEOGRAPHICAL COORDINATES
Longitude:
degrees East
Latitude:
degrees North

minutes
minutes

seconds
seconds

7. ANTENNA SITE
Longitude:
Latitude:

minutes
minutes

seconds
seconds

degrees East
degrees North

8. EQUIPMENT PARTICULARS
TRANMITTER(S) / TRANCEIVER(S)
MAIN TRANSMITTER
Make/Type/Model
Serial Number
Frequency Range
Max. # of Channels

SPARE EQUIPMENT

RECEIVER
Make/Type/Model
Serial Number
Frequency Range
Max. # of Channels
9. ANTENNA PARTICULARS
Type
Gain
Polarization
Beam width
Elevation Angle
Height above the ground
10. FREQUENCY :

TX
RX

(kHz / MHz)
(kHz / MHz)

Rated Power

11. BANDWIDTH AND EMISSION:

12. POINTS OF COMMUNICATION / SERVICE AREA(S)
LOCATION
DISTANCE

NOTE:

A Already Authorized

Application for Construction Permit

DIRECTIVITY

A&P

P - Proposed
Page 1 of 2

Main Office: Diversion Road, Brgy. Bolbok, Batangas City Tel # (043) 723.24.95 Fax # (043) 723.12.46
Rizal Field Office: 2/F NTC Bldg., BIR Road, Diliman, Quezon City Tel # (02) 996.0179
Cavite Field Office: Rescue 161 Bldg., LTO Compound, Imus, Cavite Tel # (046) 472.17.17
Calapan Field Office: Paras St., Brgy. Ibaba East, Calapan City, Or. Mindoro Mobile # (063) 908 3917410

13. ENCLOSURES AND OTHER ATTACHMENTS

a.) Engineering plans duly signed and sealed by a registered EcE
1.) Antenna System Layout
2.) Physical Layout of the Station
3.) Location Map
b.) Application for Permit to Possess or copy of the Permit to Possess
CERTIFICATION
We HEREBY CERTIFY and AFFIRM that the foregoing are true and correct to the best of our knowledge
and belief; that the radio station shall be constructed in accordance with the existing Radio Laws and
Regulation; and WE shall be liable for any willful false statements made on this application under the
Revised Penal Code of the Philippines.

(Signature over printed name of applicant)

CERTIFIED BY:
Name & Signature of EcE
EcE Number
PTR Number
Date issued
Place issued

:
:
:
:
:

Application for Construction Permit

Page 2 of 2

Main Office: Diversion Road, Brgy. Bolbok, Batangas City Tel # (043) 723.24.95 Fax # (043) 723.12.46
Rizal Field Office: 2/F NTC Bldg., BIR Road, Diliman, Quezon City
Cavite Field Office: Rescue 161 Bldg., LTO Compound, Imus, Cavite Tel # (046) 472.17.17
Calapan Field Office: Paras St., Brgy. Ibaba East, Calapan City, Or. Mindoro Mobile # (063) 908 3917410