3M STAT.] NMULTILATERAL-TELECOMMIUNICATIONS-OCT. 2, 1947 1977, (App. 2 n) Particulara concerning the station, the centraiing ooffi or inspection service reporting the irregularit or infrinngment: 6. Name (in BLOCK letters) ........................... 7. Call sign (n BLOCK letters) ........................... Nationality ........................... 9. Approximate Position [Notes c) and h)] ........................... Details of the irregularityor infringement: 10. Name [Note d)] of the station (in BLOCK letters) in communication with the station committing the irregularity or infringement ........................... 11. Call sign (in BLOCK letters) of the sta- tion in communication with the station com- mitting the irregularity or infringement .......................... 1. Time [Note e)] and date ........................... 18. Nature of the irregularity or infringemont [Note ........................... 14. Extracts from ship log and other docu- ments supporting the report (to be con- tinued on the back of the form, if neces- r) .............. ........... Informatio ono the transmitting station which was subject to interference [Note g)]: 16. Name of the station (in BLOCK letters) which was subject to interference ........................... 16. Cal sign (in BLOCK letters) ........................... 17. Frequency assigned (ke/s or Me/s) ........................... 18. Frequency measured at the time of the in. terference .......................... 19. Class of emission and width of the band ........................... 0. Reeeiving location (in BLOCK letters) where the interference was troubleomae rNotes a)nd A) ...........................
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