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[null,"スプリアス発射及び不要発射の強度確認届出書（アマチュア局の保証用）"]
[]
[{"$nulls":10},"令和　　 年　　 月　　 日"]
[{"$nulls":5},"殿"]
[{"$nulls":8},"免許人名　"]
[]
[null,"　無線設備規則の一部を改正する省令（平成17年総務省令第119号）附則第3条第１項の規定の適用を受けている無線設備について、同令附則第２条に規定する新規則の条件に適合することの確認に係る保証を受けたので、下記のとおり現在の無線設備規則の基準に合致することを届け出ます。"]
[]
[null,"記"]
[]
[null,"免許番号",{"$nulls":4},"識別信号（呼出符号）"]
[null,"①","装置の区別","②",null,"③",{"$nulls":5},"備考"]
[null,"保証対象",null,"技術基準適合証明番号\n又は工事設計認証番号",null,"発射可能な電波の型式及び周波数の範囲","変調方式","終段管",null,null,"定格\n出力\n(W)"]
[{"$nulls":7},"名称個数","電圧"]
[]
[null,"□","第　１送信機",{"$nulls":6},"V"]
[null,"□","第　２送信機",{"$nulls":6},"V"]
[null,"□","第　３送信機",{"$nulls":6},"V"]
[null,"□","第　４送信機",{"$nulls":6},"V"]
[null,"□","第　５送信機",{"$nulls":6},"V"]
[null,"□","第　６送信機",{"$nulls":6},"V"]
[null,"□","第　７送信機",{"$nulls":6},"V"]
[null,"□","第　８送信機",{"$nulls":6},"V"]
[null,"□","第　９送信機",{"$nulls":6},"V"]
[null,"□","第　10送信機",{"$nulls":6},"V"]
[null,null,"注１　本届出書は無線局１局ごとに作成すること。"]
[null,null,"注２　①の欄において、新スプリアス規格に適合することの確認に係る保証の対象送信機にレ印を記入すること。"]
[null,null,"注３　②の欄において、技術基準適合証明番号等を記載した場合は、③の欄は記載を要しない。"]
[null,null,"注４　本様式に全部を記載することができない場合は、上表と同様の別紙を作成し記載すること。"]