DECLARATION FORM

The Licensee, REVCOM, hereby declares that, to the best of their knowledge, their radio system complies with all licence conditions specified under the licence No. 266109.

Signature of Licensee…………………………….		Date……………………….

Print Name………………………………………..		Tel. No…………………….

I declare that the radio installation under this licence No. 266109 fully meets all licence conditions and that the system has been tested to ensure that all technical parameters are within the specified limits.

Signature of Radio Supplier………………………		Date…………………………

Print Name………………………………………..		Tel. No………………………

Licence Number

	266109

WARNING

It is an offence under the Wireless Telegraphy Act 1949 to install and/or use radio equipment other than in accordance with its relevant licence.

Please sign this document and return to the relevant local office covering your postcode area.