Page:United States Statutes at Large Volume 54 Part 2.djvu/379

 54 STAT.] MULTILATERAL-TELECOMMUNICATION-APR. 8, 1938 1599 APPENDIX 5 Report of a Violation of the Telecommunications Convention or of the Radio Regulations (See article 13) Ante, p. 1491. Particularsconcerning the station violating the Regulations 1. Name, if known (in printed letters) [Note (a)].. 2. Call signal (in printed letters). . . .. .. . ..... 3. Nationality, if known .............. 4.Waveused(keorm).............. 5. System [Note (b)] ................ Particularsconcerning the station reporting the irregularity 6. Name (in printed letters)................. 7. Call signal (in printed letters)............. . . 8.Nationality... ..... .. ..... .... 9. Approximate position [Note (c)].......... Details of the irregularity 10. Name [Note (d)] of the station in communication with the station committing the violation .... 11. Call signal of the station in communication with the station committing the violation. . . . . ... 12. Time [Note (e)] and date ... .. .. .. . ..... 13. Nature of the irregularity [Note (f)] ........ 14. Excerpts from ship log and other documents supporting the report (to be con- tinued on reverse side, if necessary). Time. 15. Certificate. I certify that the foregoing report represents, to the best of my knowledge, a complete and accurate account of what took place. Date:.......19....(*).............. (*) This report must be signed by the operator who called attention to the violation, and countersigned by the master of the ship or aircraft, or by the chief of the land station. ..... ..... .. .. ...... .... ..... . .. .. ...... .. .. ...... ..... . . o.. ........... . .. .. .. ...

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