After completion and verification, the ATO has to submit this present form to Licensing department

Transcription

1 BELGIAN CIVIL AVIATION AUTHORITY EUROPEAN UNION BALLOONS - Application for Part-FCL Private pilot licence / Light aircraft pilot licence Date of reception: After completion and verification, the ATO has to submit this present form to Licensing department False representation statement Any incorrect information could disqualify the applicant from taking any examination or being granted a personnel licence, certificate, rating, authorisation or attestation. 1. Applicant details to be completed by the applicant Title: Forename(s): Surname: Date of birth (dd/mm/yyyy): Town of birth: Permanent address: Telephone: Nationality: Country of birth: Postcode: Alternative telephone number: Fax number: Copy of your valid passport, EEA/EU national identity card or full EU photographic driving licence 2. Address for correspondence (if different from above) to be completed by the applicant Postal address: Postcode: 3. Medical fitness to be completed by the applicant Class of medical certificate held Date of last medical Expiry date CAA use only Note: Your medical certificate must be valid on the licence issue date. Copy of Part-MED medical certificate (Class LAPL, 1 or 2) Page 1 of 6 LA/L-PEL/0102D57E ARA.FCL.200 Vers: 0.1 Issued : 01/04/2013

2 4. Particulars of third country ICAO licences held to be completed by the applicant Issuing authority Type/Class of licence Licence number Expiry date Copy of your third country ICAO licences and medical 5. Ratings held to be completed by the applicant Please give the date of the most recent Skill test, licensing proficiency check or revalidation by experience for each type or class rating, and any instructor certificate to be endorsed on your Part-FCL licence. Rating or certificate held Single-pilot (SP) or Multi-pilot (MP) Date of test Date of IR test Expiry date of rating Examiners certificate number and name CAA use only Original Part-FCL licence Copy of your third country ICAO licences Page 2 of 6 LA/L-PEL/0102D57E ARA.FCL.200 Vers: 0.1 Issued : 01/04/2013

3 6. Application to be completed by the applicant I am applying for the following balloon licence: BPL LAPL Balloon pilots licence: Group A Group B Hot air balloons and hot air airships with a maximum envelope capacity of 3400m³. Gas balloons with a maximum envelope capacity of 1260m³. Hot air balloons and hot air airships with an envelope capacity between 3401m³ and 6000 m³. Gas balloons with an envelope capacity of more than 1260m³. Group C Hot air balloons and hot air airships with an envelope capacity between 6001m³ and m³ Group D Hot air balloons and hot air airships with an envelope capacity of more than 10500m³. Tethered Un-tethered Both LAPL Balloon: Hot air Gas Hot air balloons and hot air airships with a maximum envelope capacity of 3400m³. Gas balloons with an envelope capacity of more than 1260m³. Tethered Un-tethered Both Conversions : ICAO licence to BPL (please specify Group): 7.1 Flying experience - BPL to be completed by the applicant Hours claimed Qualifying hours CAA use only Dual instruction 12 Supervised solo flight time 1 flight (30 minutes duration) Total hours 16 Total inflations 10 Total take-offs and landings 20 Tethered instructional flights CAA use only Dates: Minimum 3 (2 within last 24 months) Original flying logbooks Page 3 of 6 LA/L-PEL/0102D57E ARA.FCL.200 Vers: 0.1 Issued : 01/04/2013

4 7.2 Flying experience - LAPL to be completed by the applicant Hours claimed Qualifying hours CAA use only Date of pre-entry flight test Credit for PIC experience in balloons after ATO assessment Applicants with prior experience as PIC may be credited towards the LAPL(B) flying experience requirements. The amount of credit shall be decided by the ATO where the pilot undergoes the training course, on the basis of a pre-entry flight test. Dual instruction 12 Supervised solo flight time 1 flight (30 minutes duration) Total hours 16 Total inflations 10 Total take-offs and landings 20 Tethered instructional flights CAA use only Dates: Minimum 3 (2 within last 24 months) Original flying logbooks 8. ATO certification and recommendation to be completed by the approved training organization I certify that (name) has satisfactorily completed a course of training for the grant of a balloon pilot s licence or Light aircraft pilot licence. I further certify that I have examined the applicants flying logbook and that the entries in them meet in full the flying experience requirements for the grant of a Balloon pilot s licence or Light aircraft pilot licence in accordance with Part-FCL. Recommended for skill test by (name): Licence N Approved training organisation (ATO): ATO approval N Competent authority issuing approval: Name of head of training: Signature (head of training): Copy of Part-ORA ATO approval certificate (if ATO is not approved by the Belgian CAA) Page 4 of 6 LA/L-PEL/0102D57E ARA.FCL.200 Vers: 0.1 Issued : 01/04/2013

5 9. Confirmation of theoretical knowledge examination to be completed by the approved training organization conducting the theoretical training I am applying for the following balloon licence: PPL LAPL Theoretical knowledge training completed on course Details of competent authority with whom the examinations were taken: hours. Approved training organisation (ATO): ATO approval N Competent authority issuing approval: Name of head of training: Signature (head of training): Certified copy of theoretical knowledge examination results (if ATO is not approved by the Belgian CAA) Copy of Part-ORA ATO approval certificate (if ATO is not approved by the Belgian CAA) 10. Confirmation of skill test to be completed by the examiner I certify that (name) a: BPL skill test LAPL(B) skill test Pass date: Pass date: has satisfactorily completed I further certify that I have examined the applicants flying logbook and that the entries in them meet in full the flying experience requirements for the grant of a licence in accordance with Part-FCL. Balloon type and registration: Name of examiner: Examiner N Authorising competent authority: Signature (examiner): Date of examiners briefing: Copy of Part-FCL examiner s approval certificate (if examiner is not approved by the Belgian CAA) Note - Examiners are reminded that they must complete the Examiners Report Form and submit this to Licensing department, within 14 working days from the skill test. Applicants are advised that the licence will not be issued until the corresponding Examiners Report Form is received. 11. Declaration of applicant to be completed by the applicant I declare that the information provided on this form is correct. I have fully reviewed all applicable guidance material and have submitted all of the necessary paperwork for my application to be considered. Signature (applicant): Page 5 of 6 LA/L-PEL/0102D57E ARA.FCL.200 Vers: 0.1 Issued : 01/04/2013

6 12. CAA use only Payment type Visa Master Card Debit card Electronic transfer Date of issue: Remarks: Prepared by: Signed by: Evaluation box can be completed by the applicant Please complete this box afterwards to give us your evaluation of the quality of the service provided Good Average Poor Remarks/comments: Page 6 of 6 LA/L-PEL/0102D57E ARA.FCL.200 Vers: 0.1 Issued : 01/04/2013