APPLICATION FOR EQUIPMENT TYPE APPROVAL IN LESOTHO

1.	Name and address of company within the borders of Lesotho in whose name the Type Approval Certificate must be issued:

Name of company:  _____________________________________________________________________

Physical Address:   _____________________________________________________________________

	_____________________________________________________________________

	_____________________________________________________________________

Postal Address:	_____________________________________________________________________

	_____________________________________________________________________

	_____________________________________________________________________

Contact Person:________________________________________________________________________

Website: ___________________________________      e-mail:	_________________________________

Telephone No.: +_____ ____________Fax No.: +_____ _____________ Mobile : ___________________

2.	Name and address of any other person or organization acting on behalf of the applicant:

Name: _______________________________________________________________________________

Name of organization : __________________________________________________________________

Address:     ___________________________________________________________________________

	___________________________________________________________________________

                    ___________________________________________________________________________

Contact Person: __________________________________   e-mail: ______________________________

Telephone No. : ___________________ Fax No. :________________Mobile No.: ___________________  

3.	Technical Description of Equipment:
3.1.	 Name of Equipment:
           _________________________________________________________________________________
3.1.1.	Manufacturer: ______________________________________________________________
3.1.2.	Model: ____________________________________________________________________
3.1.3.	Frequency Range:___________________________________________________________
3.1.4.	ITU Emission Code:__________________________________________________________
3.1.5.	Modulation:_________________________________________________________________
3.1.6.	Power Output:_______________________________________________________________
3.2.	Details of similar equipment marketed in the SADC region (if different from the original manufacturing equipment)
3.2.1.	Category:__________________________________________________________________
3.2.2.	Model:_____________________________________________________________________	

4.	Intended use within Lesotho
____________________________________________________________________________________	

5.	Modifications (if any) to rectify non-compliance. (Attach additional sheets if required)
______________________________________________________________________________________	

6.	Documentation Enclosed (tick off √)

                   Test report	

                   Operating Instructions     	
                Declaration of conformity/certificate	                   Description of repair service in Lesotho	
                Circuit Diagram	                   Receipt on payment of application fee	
                Brief Technical description (product sheet) 	                   Other (describe)	
                Copy of markings	                   Other (describe)  

7.	Person(s) to whom technical enquiries may be directed.
Name: __________________________________             Telephone No: __________________________
Signature: _______________________________             Date: __________________________________	

8.	LTA-OFFICIAL:
Application received date : _____________________           Signature: ____________________________
Decision on application: _______________________            Signature: ____________________________
Decision sent to applicant date: _________________            Signature: ____________________________