The New Zealand Association of Radio Transmitters Incorporated

2006 Application to remove a Client
Record from the Radio Spectrum
Management Register

PO Box 40-525 Upper Hutt

The Radio Spectrum Management Database is a Government register established and maintained under the Radiocommunications Act 1989. A callsign cannot be removed from the register, or given to a family member who is qualified to hold the callsign, unless either the ARX at NZART or RSM receives a direct instruction from a person with authority to make the request.

Please fill in as much of this form as is known and return to NZART at the above address.

I, the undersigned, instruct NZART to action the following callsign(s) and information in the MED database:

Name:

Address:

City:

Date of Birth:

Callsign(s):

Reason for Application:

Options: (Please cross out the option that does not apply)

1. I instruct NZART/MED to remove the callsign(s) __________________ from the MED Register. I understand that the callsign(s) will not be reallocated for a period of 12 months unless I make a direct request for the callsign(s) to be reallocated to a specific person within this period.

2. I instruct NZART/MED to remove the callsign(s) __________________ from the MED Register. I give my permission to allocate the following callsign(s) to the following qualified person/people/organisation.

Callsign         Person/Organisation

NZART Membership: Please remove the above person from NZART Membership:

NZART Membership Number _____________ (If Known)

1. Now: (Break-In delivery will cease ASAP)

2. At the end paid subscription: (Break-In will continue until the subscription expires)

(Please cross out option that does not apply.)

Name: _______________________ Signature: ________________

Relationship to client: Next of Kin / Power of attorney / Executor in Estate / Solicitor acting for Executor