1. môc ®Ých b¶n khai

CÊp míi                   Bæ sung hoÆc thay ®æi        cho giÊy phÐp sè....................................

2. ®Þa ®iÓm ®Æt thiÕt bÞ ph¸t sãng vt®:

2a. Tªn trô së ®Æt thiÕt bÞ:

2b. Sè nhµ:

2c. §­êng phè (Th«n, xãm):

2d. Ph­êng (x·):

2e. QuËn (HuyÖn):

2f. Thµnh phè (TØnh):

3 . Tªn tr¹m mÆt ®Êt :

3 a . H ô hiệu (®Ò nghÞ )

3b . Lo¹i tr¹m :

4. c¸c sè liÖu liªn quan ®Õn vÖ tinh mµ tr¹m mÆt ®Êt liªn l¹c * (chØ khai ®èi víi c¸c tr¹m mÆt ®Êt cÇn phèi hîp quèc tÕ)

4a. Tªn ®¨ng kÝ cña vÖ tinh víi ITU

4b. M· hå s¬ ®¨ng kÝ cña vÖ tinh

API/A/................   CR/C/...................  AR11/A/ ....................   AR11/c/ ....................

4c. C¬ quan qu¶n lý vÖ tinh

4d. VÞ trÝ quü ®¹o cña vÖ tinh (⁰)

4e. §é réng b¨ng th«ng cña bé ph¸t ®¸p

5 . ®¨c ®iÓm thiÕt bÞ ph¸t hoÆc thu - ph¸t VT§

5a. Lo¹i thiÕt bÞ

5b. Sè s¶n xuÊt

5c. H·ng s¶n xuÊt

5d. KiÓu ®iÒu chÕ

5e. Tæn hao Fider (dB)

5f. D¶i tÇn (MHz)

Tõ:                     §Õn:

5g. Tèc ®é truyÒn (Mb/s)

5h. KÝ hiÖu bóp sãng thu vÖ tinh * (chØ khai ®èi víi c¸c tr¹m mÆt ®Êt cÇn phèi hîp quèc t ế )

5i. C¸c ®Æc tÝnh chung cña tÇn sè ph¸t

1.TÇn sè ph¸t (®Ò nghÞ)

(MHz)

2. Ph­¬ng thøc ph¸t hoÆc §é réng b¨ng tÇn cÇn thiÕt (MHz)

3. C«ng suÊt ®Ønh cùc ®¹i

(dBW)

4. C«ng suÊt ®Ønh cùc tiÓu

(dBW)

6 . §Æc ®iÓm thiÕt bÞ thu VT§

6a. Lo¹i thiÕt bÞ

6b. Sè s¶n xuÊt

6c. H·ng s¶n xuÊt

6d. KiÓu ®iÒu chÕ

6e. D¶i tÇn thu (MHz)

6f. §é réng b¨ng tÇn cÇn thiÕt (MHz)

6g. Tèc ®é thu (Mb/s)

6h. §é nh¹y (dBm)

6i. NhiÖt ®é t¹p ©m (^o K) hoÆc hÖ sè t¹p ©m

6j. KÝ hiÖu bóp sãng ph¸t vÖ tinh * (chØ khai ®èi víi c¸c tr¹m mÆt ®Êt cÇn phèi hîp quèc t ế )

6k. C¸c ®Æc tÝnh chung cña tÇn sè thu

1. TÇn sè thu ®Ò nghÞ

(MHz)

2. Ph­¬ng thøc ph¸t hoÆc §é réng b¨ng tÇn cÇn thiÕt (MHz)

3. Tû sè C/N

(dB)

7.Anten

7a. Anten dïng cho:

     - Ph¸t                                     - Thu                                      - Thu/ph¸t

7b. KiÓu

7c. KÝch th­íc (m)

7d. VÞ trÝ ®Æt anten

               Kinh ®é :             E                ^{'                    "}                             VÜ ®é :                  N                    ^{'                    "}

7e. Gãc ph­¬ng vÞ (⁰)

7f. Gãc ngÈng (⁰)

7g. §é cao anten (so víi mÆt ®Êt) (m)

7h. §é cao ®Þa h×nh (so víi mùc n­íc biÓn) (m)

7i. HÖ sè khuÕch ®¹i (dBi)

- Anten ph¸t:                                                       - Anten thu:

7j. §é réng bóp sãng chÝnh ( ⁰ )

- Anten ph¸t:                                                       - Anten thu:

7k. Ph©n cùc

- Anten ph¸t:                                                       - Anten thu:

8. Gi¶n ®å bøc x¹ cña anten

         REC-580 (ITU)                                                 REC-465 (ITU)

         AP28  hoÆc AP29 (ITU)                                   Kh¸c

9. Ngµy dù ®Þnh ®­a vµo khai th¸c

10. Giê ho¹t ®éng

 Xin cam ®oan kª khai ®óng vµ chÞu hoµn toµn tr¸ch nhiÖm víi b¶n khai; thùc hiÖn nghiªm chØnh quy chÕ sö dông tÇn sè vµ thiÕt bÞ ph¸t sãng VT§.

§iÒn vµo kho¶ng trèng c¸c ®Ò nghÞ hoÆc c¸c th«ng tin bæ sung:

1. Type of application

New Licence         Amendment or supplementation        to the existing licence No............

2. Place of installation of  the radio equipment :

2a. Name 

2b. No:

2c. Street

2d. Division:

2e. District:

2f. City(Province):

3 . Name of Earth Station

3a. Station ID

3b . Type of station :

4 . Associated space station details

4a. Satellite network

4b. Special sections

API/A/................   CR/C/...................  AR11/A/ ....................   AR11/C/ ....................

4c. Owner of satellite

4d. Satellite orbital location (⁰)

4e. Bandwidth of  transponder (MHz)

5 . Transmitter details

5a. Type of transmitter

5b. Model

5c. Manufacturer

5d. Modulation

5e. Fider Loss(dB)

5f. Frequency band (MHz)

From:                     To:

5g. Bit rate (Mb/s)

5h. Associated satellite receiving beam designation

5i. Common characteristics of  transmitting frequencies

1.Transmitting frequency (preferred)

(MHz)

2. Designation of emission or necessary bandwidth (MHz)

3. Maximum peak Power

(dBW)

4. Minimum Peak Power

(dBW)

6 . Receiver Details

6a. Type of Receiver

6b. Model

6c. Manufacturer

6d. Modulation

6e. Frequency band (MHz)

From:               To:

6f. Necessary bandwidth

6g. Bit rate (Mb/s)

6h. Sensitivity (dBm)

6i. Noise tempera ture (⁰K) or Noise Figure (dB)

6j. A ssociated satellite transmitting  beam designation

6k. Common characteristics of receiving frequencies

1. Receiving frequency (preferred)

(MHz)

2. Designation of emission or necessary bandwidth (MHz)

3. C/N Ratio

(dB)

7.Antenna

7a. Antenna:

     - Transmit                             - Receive                             -Transmit/Receive

7b. Type/Model

7c. Diameter (m)

7d. Geographical                         Coordinates

Longitude :             E                ^{'                    "}                       Latitude :                  N                    ^{'                    "}

7e. Azimuth (⁰)

7f. Elevation Angle (⁰)

7g. Height (above ground level) (m)

7h. Ground height  (above sea level) (m)

7i. Gain (dBi)

- Transmit Antenna :                                           - Receive Antenna:

7j. Beamwidth ( ⁰ )

- Transmit Antenna :                                           - Receive Antenna:

7k. Polarization

- Transmit Antenna :                                           - Receive Antenna:

8. Radiation Pattern

         REC-580 (ITU)                                                 REC-465 (ITU)

         AP28  or AP29 (ITU)                                        Others

9. Date of bringing into use

10. Working hours

I declare that all information that I have provided in this application form is correct, to the best of my knowledge and belief.

Additional information (if any)