SINGLE-PILOT AEROPLANE (Non-HPCA)

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1 SINGLE-ILOT EROLNE (Non-HC) SKILL TEST ROFICIENCY CHECK Licence Endorsement: IC CO-ILOT VFR IFR pplication and report form. Udfyldes af ansøgeren/to be filled out by the applicant: CR-nr./Date of Birth: Certifikat nr./licence no.: (If any) Udstedende Stat/State of Licence Issue: Fornavne/First name(s): Efternavn/Last name: Gade eller vej:/street: ostnr. og by/ostal code and city: Tlf./Telephone: Dato for underskrift/date of signature: Underskrift/Signature: B: Udfyldes af skolen/to be filled out by TO: Name of TO: (Use stamp): Specification of flight time Only Skill Test for the issue of Class/type rating and Instrument Rating Total: IC: Instrument time:: Flight time during training: Total: Instrument: E: Specification of flight time roficiency check Total: Total on class/type: Route sectors latest validity period: If issue or renewal: Flight time during training: I hereby certify that the applicant has passed the required training and that the applicant fulfils all the requirements for the test or check to be taken Date of signature of Head of Training Name and Signature of Head of Training C: To be filled out by the Examiner: Date of test: Licence Endorsement: Type of aircraft: Name of Examiner or stamp: Stamp of Examiner, uthorisation no. of Examiner or stamp: I hereby certify that the applicant has passed the required training and that the applicant fulfils all the requirements for the test or check to be taken Date of signature of Examiner Signature of Examiner Section 1: Final result: Section 2: Section 3: Result of the test Section 4: Section 5: Temporary licence issued (copy enclosed): Section 6: Not pplicable artial ass Yes No Valid until: roficiency check only: I have entered the following details in the applicants licence: Rating Date of check Valid until Rating Date of check Valid until S() Non-HC december 2014 age 1 of 5 Trafikstyrelsen, Edvard Thomsens Vej 14, 2300 Kbh. S., Tlf.: ,

2 For detailed instructions see Commision Regulation 1178/2011 ppendix 9 Name of pplicant: SECTION 1 Departure 1.1 re-flight, incl. Documentation, ass and Balance, Weather briefing, NOT 1.2 re-start checks. External/internal 1.3 Engine starting: Normal and malfunctions 1.4 Taxiing 1.5 re-departure checks. Engine run-up 1.6 Take-off procedures (crosswind if available) 1.7 Climbing: Vx/Vy, Turns onto headings, Level off 1.8 TC liaison - Compliance, R/T procedure SECTION 2 irwork (VC) 2.1 Straight and level flight at various airspeed 2.2 Steep turns (360 left and right, 45 bank) Stalls and recovery i: Clean stall 2.3 ii: pproach to stall descending turn approach configuration and power iii: pproach to stall landing configuration and power 2.4 iv: pproach to stall, climbing turn take-off flap and climb power (single engine aeroplane only) Handling using autopilot and flight director (may be conducted in section 3) 2.5 TC liaison - Compliance, R/T procedure SECTION 3 En route procedures VFR (See pp. 3 to JR-FCL note 3 and 4) 3.1 Flight plan, dead reckoning and map reading 3.2 aintenance of altitude, heading and speed 3.3 Orientation, timing and revision of ETs 3.4 Use of radio navigation aids 3.5 Flight management(flight log, routine checks including fuel, systems and icing) 3.6 TC liaison - Compliance, R/T procedure S() Non-HC december 2014 age 2 of 5

3 For detailed instructions see Commision Regulation 1178/2011 ppendix 9 Name of pplicant: SECTION 3B Instrument flight 3B.1 Departure IFR 3B.2 En route IFR 3B.3 Holding procedures 3B.4 ILS to DH/D of 200 FT or to procedure minima (utopilot may be used to glideslope intercept) 3B.5 Non-precision approach to DH/ and Flight exercises including simulated failure of compass and attitude indicator 3B.6 Rate 1 turns Recoveries from unusual attitudes 3B.7 Failure of localiser or glideslope 3B.8 TC liaison - Compliance, R/T procedure SECTION 4 rrival and landings 4.1 erodrome arrival procedure 4.2 Normal landing 4.3 Flapless landing 4.4 Crosswind landing (if suitable conditions) 4.5 pproach and landing with idle power from up to 2000 FT (single engine aeroplane only) 4.6 Go-around from minimum height 4.7 Night go-around and landing (if applicable) 4.8 TC liaison - Compliance, R/T procedure SECTION 5 bnormal and emergency procedures. (This section may be combined with sections 1 through 4) 5.1 Rejected take-off at a reasonable speed Simulated engine failure after take-off 5.2 (single engine aeroplanes only) 5.3 Simulated forced landing without power (single engine aeroplanes only) 5.4 Simulated emergencies i: Fire or smoke in flight ii: Systems malfunctions as appropriate 5.5 Engine shutdown and restart (E Skill test only) 5.6 TC liaison - Compliance, R/T procedure S() Non-HC december 2014 age 3 of 5

4 For detailed instructions see Commision Regulation 1178/2011 ppendix 9 Name of pplicant: SECTION 6 Simulated asymmetric flight (This section may be combined with sections 1 through 5) 6.1 Simulated engine failure during take-off (t as safe altitude unless carried out in or FNT II) X 6.2 symmetric approach and go-around 6.3 symmetric approach and full stop landing 6.4 TC liaison - Compliance, R/T procedure Details of the flight Destination aerodrome On block On ground Departure aerodrome Off block irborne ircraft registration Total block time Total airborne time No. of landings: Remarks/Overall assessment/reasons for failure (if applicable): Name of instructor present at the Skill Test: Signature of Examiner: Signature of pplicant: S() Non-HC december 2014 age 4 of 5

5 For detailed instructions see Commision Regulation 1178/2011 ppendix 9 Name of pplicant: In accordance with R.GEN.315(a), (b) (c) Undertegnede bekræfter hermed, at jeg ved ansøgningstidspunktet Note: 1. ikke var ikke i besiddelse af et personligt certifikat, rating, tilladelse eller attestation med samme anvendelsesområde og i samme kategori udstedt i en anden medlemsstat; 2. ikke har ansøgt om et personligt certifikat, rating, tilladelse eller attestation med samme anvendelsesområde og i samme kategori i en anden medlemsstat; og 3. aldrig har haft et personligt certifikat, rating, tilladelse eller attest med samme anvendelsesområde og i samme kategori udstedt i en anden medlemsstat, som er tilbagekaldt eller suspenderet i anden medlemsstat. Ukorrekte oplysninger vedrørende ovenstående, kan være diskvalificerende for udstedelse af certifikat, rating, tilladelse m.v. Undersigned hereby confirm that I at the time of application 1. was not holding any personnel licence, certificate, rating, authorisation or attestation with the same scope and in the same category issued in another ember State; 2. has not applied for any personnel licence, certificate, rating, authorisation or attestation with the same scope and in the same category in another ember State; and 3. has never held any personnel licence, certificate, rating, authorisation or attestation with the same scope and in the same category issued in another ember State which was revoked or suspended in any other ember State. 4. Note: Incorrect information regarding the above can be disqualifying for obtaining a certificate, rating, authorization, etc. Dato:/Date: Underskrift:/Signature: S() Non-HC december 2014 age 5 of 5

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