1. Instructions
Before submitting complaint, ensure that your system is operating in accordance with the license conditions.

2. Complainant’s details
Company/Organization name (*):
License number:
Name of contact person:
Address (District and sector)::
P.O.Box :
Telephone (*) :
E-mail (*):
3. Affected system/service details
Frequency of affected site ::
Location/Coordinates of affected site :
Type of service:
FM Radio  TV  Fixed Wireless  GSM/IMT  HF/VHF radio  Satellite 
Others (Please specify):
Type of modulation:
Antenna/System information:
Antenna height:
Output Power:
Affected bandwidth:
4. Interference details
Date when interference started:
Interference duration:
What effect does the interference signal make on your equipment?
(e.g. Voices, Buzz, tones, etc.)
Any additional information :
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