Application For Amateur Radio License Form CA F FSM 02 1

Application for Amateur Radio Station License CA/F/FSM/02
1. APPLICATION REQUIREMENTS:
Applications should be completed in English and certified translations provided
for relevant documents.
(Check list- for Official use only)
1.1. This application should be accompanied by a sworn affidavit
submitting the documents listed therein in line with the template at
Annex 1 below:
1.2. Foreign persons not based in Kenya applying for Amateur Licenses
should notarize all their documents.
1.3. Copies of : -
1.3.1. Kenyan National Identity Cards or Kenyan/Foreign
passports of the applicant or Parent/Guardian in case of
Novice.
1.3.2. Both sides of the ID should be copied onto the same side
of an A4 size paper (only new generation IDs are
acceptable)
1.3.3. Passports copies should include pages showing the
nationality, date of issue and expiry, holder’s name,
photograph and Kenyan Visa for foreigners.
1.3.4. Certificate of a recognized Radio Amateur Examination or
valid and current license.
1.4. Payment of a non-refundable application fee of KShs 1,000.00
2. THE COMPLETED APPLICATION FORM SHOULD BE RETURNED TO: -

The Director General,
Communications Authority of Kenya
P. O. Box 14448, Westlands – 00800
Nairobi, Kenya
3. TYPE OF AMATEUR LICENCE APPLIED FOR

(Tick one only)
PERMANENT AMATEUR LICENCE FOR KENYA NATIONALS
AND RESIDENTS (renewable annually)
TEMPORARY AMATEUR LICENCE FOR FOREIGNERS
(valid for a maximum period of one year only from date of issue)
Note: For foreigners there should exist diplomatic ties between the two
countries and the applicant home license should meet Kenyan license
qualifications and standards)
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NOVICE AMATEUR LICENCE FOR STUDENTS

(Renewable Annually)
4. PARTICULARS OF APPLICANT
4.1. NAME OF APPLICANT AS IT APPEARS ON THE ID/PASSPORT

(The Applicant name should be written in CAPITALS and in full in the order it appears on the
National ID/Passport)
CALL SIGN (IF ANY):_______________________
LICENSE ISSUING AUTHORITY AND E-MAIL ADDRESS:_____________

___________________________________________________________________
4.2. KENYA NATIONAL IDENTITY CARD NUMBER
0 1 2 3 4 5 6 7 8 9
4.3. OR PASSPORT NUMBER
0 1 2 3 4 5 6 7 8 9
4.4. APPLICANT DATE OF BIRTH

----- ------ ---------
dd mm yyyy
5. PARENT/GUARDIAN CONTACT FOR NOVICE AMATEUR APPLICANTS

(All applications for Novice Amateur license MUST fill this part. Any change in the
information given here should be communicated in writing to the Authority within one
month from the date of change)
5.1. KENYA NATIONAL IDENTITY CARD NUMBER

0 1 2 3 4 5 6 7 8 9
5.2. OR PASSPORT NUMBER

0 1 2 3 4 5 6 7 8 9
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5.3.
ADDRESS:
Town______________________ Street/Road____________________
Name of Building_______________ LR No_______________________
Floor__________ Office__________
P. O. Box__________________________ Town_____________________
Telephone__________________________ Email ____________________
REFERENCES (for Kenyan residents only)
5.4. First Reference
Name________________________________________________________________
P. O. Box__________________________ Town________________________
Telephone__________________________ Email _______________________
5.5. Second Reference
Name_________________________________________________________________
P. O. Box__________________________ Town_________________________
Telephone__________________________ Email ________________________
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6. DECLARATION
I hereby certify the information I have provided in this application is true and correct to
the best of my knowledge. I understand that it is an offence under the laws of Kenya to
give false information in support of any application.
Name of Applicant_______________________________________________________
Signature_____________________________Date_______________________________
(For Novice applicant only)

Name of Parent/Guadian___________________________________________________
Signature_____________________________Date_______________________________
FOR OFFICIAL USE ONLY
The application MEETS/ DOES NOT MEET the Authority’s requirements and is hereby
APPROVED/NOT APPROVED as follows: -
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
The reasons for not approving the application are as follows: -
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Name of Approving Officer_________________________________________________
Designation______________________________________________________________
Signature_______________________________Date_____________________________
Official stamp
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ANNEX 1: TEMPLATE OF THE AFFIDAVIT TO BE SUBMITTED
REPUBLIC OF KENYA
IN THE MATTER OF OATHS AND STATUTORY DECLARATIONS ACT CHAPTER 15,

LAWS OF KENYA
AND
IN THE MATTER OF AN APPLICATION FOR LICENSE FROM THE COMMUNICATIONS

AUTHORITY OF KENYA
AFFIDAVIT
I, __________________________________________________ of Post Office Box
Number ____________ (Town)_____________________________(Postcode)

_______do hereby make oath and state as follows:
1. THAT I am an adult of sound mind and ___________________
(position/ status in the applicant entity) of _________________________________

(name of the applicant) and hence competent to swear this Affidavit.
2. THAT I am a citizen of the _______________________________ and holder of
National Identity Card No. (or Passport No.) ____________________________ .
3. THAT __________________________________________(name of the applicant)

has resolved to make an application to the Authority for the operations of Amateur
Radio Station licence.
4. THAT I have submitted the following copies of our documents in support of the said
application:
4.1. Registration and ownership status:

4.1.1 copies of Kenyan National Identity Cards (ID) or Kenyan passports
for the Applicant:
4.1.2 Passport copies pages showing the nationality, date of issue and expiry,
name and photograph of holder.
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4.1.3 Both sides of the National ID copied onto the same side of an A4 size
paper, and
4.2 Certificate of a recognized Radio Amateur Examination or valid and current
license.
5. THAT I swear that the documents listed in 4 above are authentic copies of the
original documents issued by the relevant authorities to the applicant.
6. THAT this Affidavit is sworn in support of __________________________

(Applicant’s name) application for Amateur Radio Station licence..
7. THAT what is deponed to herein above is true and within my own knowledge.
SWORN at _________________by the said )

)
______________________________________ ) _______________________
) (Deponent)
This __________day of ________ in the year_______ )
)
BEFORE ME )
)
)
)
COMMISSIONER FOR OATHS )
Drawn by:
_____________________________________(Law Firm)
_____________________________________(Physical Address)
P. O. Box ____________________
_____________________________ (Town)
_____________________________ (Postal Code)
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Application for Amateur Radio Station License CA/F/FSM/02

1.4. Payment of a non-refundable application fee of KShs 1,000.00

2. THE COMPLETED APPLICATION FORM SHOULD BE RETURNED TO: -

3. TYPE OF AMATEUR LICENCE APPLIED FOR

NOVICE AMATEUR LICENCE FOR STUDENTS

4.1. NAME OF APPLICANT AS IT APPEARS ON THE ID/PASSPORT

CALL SIGN (IF ANY):_______________________

LICENSE ISSUING AUTHORITY AND E-MAIL ADDRESS:_____________

4.2. KENYA NATIONAL IDENTITY CARD NUMBER

4.3. OR PASSPORT NUMBER

4.4. APPLICANT DATE OF BIRTH

5. PARENT/GUARDIAN CONTACT FOR NOVICE AMATEUR APPLICANTS

5.1. KENYA NATIONAL IDENTITY CARD NUMBER

5.2. OR PASSPORT NUMBER

Name of Building_______________ LR No_______________________

Telephone__________________________ Email ____________________

REFERENCES (for Kenyan residents only)

5.4. First Reference

Telephone__________________________ Email _______________________

5.5. Second Reference

Telephone__________________________ Email ________________________

(For Novice applicant only)

FOR OFFICIAL USE ONLY

The reasons for not approving the application are as follows: -

Name of Approving Officer_________________________________________________

ANNEX 1: TEMPLATE OF THE AFFIDAVIT TO BE SUBMITTED

IN THE MATTER OF OATHS AND STATUTORY DECLARATIONS ACT CHAPTER 15,

IN THE MATTER OF AN APPLICATION FOR LICENSE FROM THE COMMUNICATIONS

I, __________________________________________________ of Post Office Box

Number ____________ (Town)_____________________________(Postcode)

1. THAT I am an adult of sound mind and ___________________

(position/ status in the applicant entity) of _________________________________

2. THAT I am a citizen of the _______________________________ and holder of

National Identity Card No. (or Passport No.) ____________________________ .

3. THAT __________________________________________(name of the applicant)

4.1. Registration and ownership status:

6. THAT this Affidavit is sworn in support of __________________________

SWORN at _________________by the said )

_____________________________ (Postal Code)

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Name of Building_ LR No_________

Telephone______ Email

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Number (Town)_________________(Postcode)