ICTQATAR REGULATORY AUTHORITY
APPLICATION FOR AERONAUTICAL GROUND STATION LICENSE FORM: SV/01
APPLICANT’S DECLARATION
1.1 I declare that:
• the information provided in this application is complete and correct;
• any equipment and / or radio spectrum licensed as a result of this application will be used in compliance with ictQATAR Laws and
Regulations;
• I / we will notify ictQATAR of any changes to the information provided;
• I am authorized to sign this application on behalf of the applicant.
1.2 Name: 1.6 Company stamp (if applicable):
1.3 Position:
1.4 Signature: 1.5 Date:
APPLICANT INFORMATION
2.1 ictQATAR Customer Number:
Please note. If you have an existing customer number and have previously provided the following information you need only complete
the Applicant Information sections if your details need to be amended in our records.
2.2 Name / Company / Organisation:
2.3 Nationality / Place of registration:
2.4 Profession: . .
2.5 PO Box: . .
2.6 Address: . .
. .
2.7 Main contact: . . 2.10 Position:
2.8 Contact email: . . 2.11 Mobile Tel:
2.9 Office Tel: 2.12 Fax: . .
INVOICING INFORMATION (IF DIFFERENT FROM ABOVE)
3.1 Name / Company / Organisation: . .
3.2 PO Box: . .
3..3 Address: . .
3.4 Invoicing contact: . . 3.7 Position: . .
3.5 Contact email: . . 3.8 Mobile Tel: . .
3.6 Office Tel: . . 3.9 Fax: . .
APPLICATION TYPE (TICK AS APPROPRIATE)
New application: Renewal: Modification: Cancellation:
APPLICATION SUBMISSION
Please send* completed applications to:
Regulatory Authority – Spectrum Affairs
The Supreme Council of Information & Communication Technology (ictQATAR)
* by fax, post, courier or hand deliver. P.O. Box 23264, Al Nassr Tower, Post Office Roundabout, Al Corniche, Doha, Qatar
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FOR ictQATAR INTERNAL USE
For Spectrum Planning Section:
Date Received:
Approved: Not Approved:
License Number: Staff No.
Remarks:
Date Completed:
For Spectrum Management Section:
Date Received:
Approved: Not Approved:
License Number: Staff No.
Remarks:
Date Completed:
INSTALLATION / AERODROME LOCATION
1.1 Location:
1.2 Latitude:
1.3 Longitude:
1.4 Service area (radius from base station) (km)
1.5 Call sign /system ID:
1.6 Antenna Type:
1.7 Antenna Power (e.r.p) (W)
1.8 Antenna Height:
COMMUNICATIONS SYSTEMS
2.1 General aviation
Equipment Model / Type Quantity Power erp Band assigned
2.2 Operations control
Equipment Model / Type Quantity Power erp Band assigned
2.3 Air traffic control
Equipment Model / Type Quantity Power erp Band assigned
2.4 Search and Rescue and Emergency Communications
Equipment Model / Type Quantity Power erp Band assigned
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2.5 HF communications
Equipment Model / Type Quantity Power erp Band assigned
2.6 Other uses not covered by above:
Type of use:
Equipment Model / Type Quantity Power erp Band assigned
ADDITIONAL INFORMATION
DOCUMENTS TO BE ENCLOSED
Copy of CR
Copy of Corporate card
Detailed Technical Specifications
Network Diagram1
QCAA approval/authorization
DOCUMENTS TO BE ENCLOSED (FOR CANCELLATION)
Copy of receipt of final payment
Original license
Copy of the shipment document (Airway bill & packing list)
or
Declaration that equipment will be written-off under the supervision of ictQATAR staff
1 Wherever possible an initial / planned network diagram should be provided for information in support of the application.
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