If Applicant is already a Radio AMATEUR:

Sponsors/References:

In Case of Emergency:

Persons to notify;

CERTIFICATION

This is to certify that I ____________ am a Filipino Citizen, of legal age, and a resident of ______________acknowledge and uphold the objective, adhere to the policies, rules & regulation, promulgated on the Constitution and By-Laws of HAM RADIO CEBU, INC.

Sworn this ____ day of ________________ year _____ at _______________________________
__________________________________________, Philippines.