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Frl Dprtmnt o t Environmnt, Trnsport, Enry n Communitions DETEC Frl Oi o Civil Avition FOCA Sty Division Flit Prsonnl 3003 Brn PPL(A) Skill tst Applition n rport orm Applint's lin numr: Applint lst nm: irst nm: t o irt: pl o irt: pl o oriin: ntionlity: privt rss: postl o: ity: strt: pon/x om: pon/x oi: -mil: sintur o pplint: q initil skill tst q rptition o il / prtil pss skill tst, rom t: q onvrsion to n EASA lin q upr rom LAPL(A) to PPL(A) Instrutor lst nm: irst nm: lin numr: sintur o lit instrutor: T ATO onirms tt t nit s n trin orin to t pprov syllus n ssurs t lvl o proiiny rquir. ATO nm: ristrtion numr: nm o i lit instrutor: lin numr: lotion & t: sintur o i lit instrutor: 1 Dtils o lit t: typ o ropln: ristrtion: lss: TR: prtur/stintion lok-o: lok-on: lok tim: # o lnins: 2 Rsult o skill tst *lt s nssry Applint's sintur pss* il* prtil pss* 3 Rmrks Exminr: lst nm: irst nm: xminr utoristion: lin numr: lotion n t: sintur o lit xminr: FOCA/EASA Form 60.220-06.2012 EASA AMC1 FCL.235 1/6

BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Applint's lin numr: Instrution / xprin rport A opy o t rlvnt loook ps (lit xprin & STD ps) sowin t onirm ompltion o t lit instrution must tt to tis orm. Pls mk sur to not your lin numr totr wit your sintur t t ottom o t ps. Summry o onitions n lyin xprin or PPL(A) skill tst ) Applints minimum : 17 yrs ) Enlos opy o pssport q ) EASA Mil lss q 1 or q 2 vli until: ) Tortil xmintion PPL(A) pss t: ) VFR riotlpony prtil tst pss t: Lnu proiiny MNM lvl 4 i pplil vli until: ) Totl lit xprin orin PART FCL.210.A (inl. FSTD) (Critin: Holrs o pilot lins or notr tory o irrt, wit t xption o lloons, sll rit wit 10% o tir totl lit tim s PIC on su irrt up to mximum o 10 ours. A opy o t rlvnt loook ps must sumitt.) (MNM 45 HR) ours: ) Dul instrution (MNM 25 HR) ours: o wi instrution tim FSTD (MAX 5 HR) ours: ) Solo instrution (MNM 10 HR) ours: o wi solo ross ountry (MNM 5 HR) ours: L 1 DEP DEST KM L 2 DEP DEST KM L 3 DEP DEST KM totl (MNM 270 Km rt irl istn) KM Aitionl trinin rquir or nit quliition : i) Nit lit xprin (MNM 5 HR) ours: j) Dul instrution (MNM 3 HR) ours: inl. ul ross ountry nvition (MNM 1 HR) ours: Solo tk-os n lnins (MNM 5) tk-os: lnins: FOCA/EASA Form 60.220-06.2012 EASA AMC1 FCL.235 2/6

BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Applint's lin numr: Conut o t skill tst An pplint sll pss ll pplil stions. I ny itm in stion is il, tt stion is il. Filur in mor tn on stion will rquir t pplint to tk t ntir tst in. An pplint ilin only on stion sll tk t il stion in. Filur in ny stion o t r-tst, inluin tos stions tt v n pss on prvious ttmpt, will rquir t pplint to tk t ntir tst in. All stions o t skill tst sll omplt witin six monts. Furtr trinin my rquir ollowin ny on il skill tst. Filur to iv pss in ll stions o t tst in two ttmpts will rquir urtr trinin s trmin y t Autority. Tr is no limit to t numr o skill tsts tt my ttmpt. T Autority will provi t FE wit qut sty vi to nsur tt t tst is onut sly. Soul t pplint oos to trmint skill tst or rsons onsir inqut y t FE, t pplint sll rtk t ntir skill tst. I t tst is trmint or rsons onsir qut y t FE, only tos stions not omplt sll tst in urtr lit. Any mnouvr or prour o t tst my rpt on y t pplint. T FE my stop t tst t ny st i it is onsir tt t pplint's monstrtion o lyin skills rquirs omplt r-tst. An pplint sll rquir to ly t ropln rom position wr t pilot-in ommn untions n prorm n rry out t tst s i tr is no otr rw mmr. Rsponsiility or t lit sll llot in orn wit ntionl rultions. T rout to lown or t nvition tst sll osn y t FE. T rout my n t t rorom o prtur or t notr rorom. T pplint sll rsponsil or t lit plnnin n sll nsur tt ll quipmnt n oumnttion or t xution o t lit r on or. An pplint sll init to t FE t ks n utis rri out, inluin t intiition o rio ilitis. Cks sll omplt in orn wit t utoris k list or t ropln wi t tst is in tkn. Durin pr-lit prprtion or t tst t pplint is rquir to trmin powr sttins n sps. Prormn t or tk-o, ppro n lnin sll lult y t pplint in omplin wit t oprtions mnul or lit mnul or t ropln us. T FE will tk no prt in t oprtion o t ropln xpt wr intrvntion is nssry in t intrsts o sty or to voi unptl ly to otr tri. Hinwis: Innrt 10 Tn n Zustllun s Ernisss s Skilltsts/Proiinyks knn im Bunsmt ür Zivillutrt, 3003 Brn, sritli i Ausstllun inr swräin Vrüun ür s Prüunsrsultt vrlnt wrn. Rmrqu: Il st possil, ns ls ix jours suivnt l ommunition u résultt u Skill Tst/Proiiny Ck 'otnir, sur réquêt érit uprès l'oi éérl l'vition ivil, 3003 Brn, un éision susptil rours portnt sur l résultt uit xmn. Avviso: Entro ii iorni ll'invio i rsultti llo Skill Tst/Proiiny Ck può ssr riist pr isritto ll'uiio rl ll'vizion ivil, 3003 Brn, un ision impunil sull'sito ll'sm. Rmrk: Witin 10 ys tr ript o tis skill tst/proiiny k rsult, n ppll ision out t tst / k rsults my rqust in writin to t Frl Oi o Civil Avition, 3003 Brn, usin on o t oiil lnus (Grmn/Frn/Itlin) FOCA/EASA Form 60.220-06.2012 EASA AMC1 FCL.235 3/6

BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Applint's lin numr: Us o klist, irmnsip, A/C limittions must rspt in ll stions Stion 1 1 ttmpt 2 ttmpt pss il pss il Pr-lit oprtions & prtur Pr-lit oumnttion NOTAM n Wtr riin Mss & ln n prormn lultion Aropln insption & srviin Enin strtin n tr strtin prours Txiin & rorom prours, pr tk-o prours Tk-o n tr tk-o ks Arorom prtur prours ATC omplin & R/T prours Stion 2 1 ttmpt 2 ttmpt pss il pss il Gnrl irwork ATC omplin & R/T prours Strit n lvl lit wit sp ns Climin: i. Bst rt o lim Climin turns i Lvllin o Mium (30 nk) turns Stp (45 nk) turns, inluin ronition & rovry rom spirl iv Flit t ritilly low irsp wit n witout lps Stllin: i. ln stll n rovr wit powr i Appro to stll in snin turn wit nk nl 20, ppro oniurtion Appro to stll in lnin oniurtion Dsnin: i. Wit n witout powr Dsnin turns (stp liin turns) i Lvllin o FOCA/EASA Form 60.220-06.2012 EASA AMC1 FCL.235 4/6

BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Applint's lin numr: Us o klist, irmnsip, A/C limittions must rspt in ll stions Stion 3 1 ttmpt 2 ttmpt pss il pss il En-Rout prours Flit pln, rkonin & mp rin Mintnn o ltitu, in n sp Orinttion, timin n rvision o ETAs & lo kpin Divrsion to ltrnt rorom (plnnin n implmnttion) Us o rio nvition is Bsi instrumnt lyin k (180 turn in simult IMC) Flit mnmnt (ks, ul systms & rurtor iin, t.) ATC omplin & R/T prours Stion 4 1 ttmpt 2 ttmpt pss il pss il Appro n lnin prours * * Arorom rrivl prour Prision lnin (sort il lnin), Crosswin lnin (i suitl onitions vill) Flplss lnin * Appro to lnin wit il powr (SE only) Tou n o Go-roun rom low it ATC omplin & R/T prours Ations tr lit * tis itms my omin t t isrtion o t FE FOCA/EASA Form 60.220-06.2012 EASA AMC1 FCL.235 5/6

BAZL OFAC UFAC FOCA CH-3003 Brn (Switzrln) Applint's lin numr: Us o klist, irmnsip, A/C limittions must rspt in ll stions Stion 5 Anorml & mrny prours 1 ttmpt 2 ttmpt (Tis stion my omin wit Stions 1 to 4) pss il pss il Simult nin ilur tr tk-o (SE only) * Simult or lnin (SE only) Simult prutionry lnin (SE only) Simult mrnis Orl qustions * tis itms my omin t t isrtion o t FE Stion 6 1 ttmpt 2 ttmpt (Tis stion my omin wit Stions 1 to 5) pss il pss il Simult nin ilur urin tk-o (t s ltitu unlss rri out in FFS) Simult symmtri lit n rlvnt lss/typ itms Asymmtri ppro n o-roun Asymmtri ppro n ull stop lnin Enin sut own n rstrt ATC omplin, R/T prours or irmnsip As trmin y t FE: ny rlvnt itms o t lss/typ rtin skill tst to inlu, i pplil: i. Aropln systms inluin nlin o uto pilot Oprtion o prssuriztion systm i Us o -iin n nti-iin systm Orl qustions FOCA/EASA Form 60.220-06.2012 EASA AMC1 FCL.235 6/6