Informe de Recepo

( Reception Report to Broadcasting Station )

RECEPTION REPORT TO _______________________

RECEIVER : _________________________________
ANTENNA : __________________________________
LANGUAGE : ______________
Day

DATE
Month Year

Time
(UTC)
:
:

:
:

Mode

Frequency
kHz
kHz

Sender:
_____________
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__________
Meters S
I
N
P
O
Band QSA QRM
QRN QSB QRK
m
m

PROGRAMME DETAILS (Hour : Minute / Details )

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REMARKS:
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I hope this report will be found correct and interesting to your station.
Awaiting your VERIFICATION CARD or QSL, with anticipated thanks.
I send you my best regards to all of your station team.
Please, send me your latest programme schedule: __ Yes __ No
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Signature
______________________
____/___/_____
(made by CT1FBF and CT0 1035)