Approval of Flight Conditions for a Military Permit to Fly
MDOA / MPOA Holder’s File Reference:
1. Organisation
Company/Unit Name <Insert name of organisation providing the flight conditions and associated substantiations> / 2. Registration marks
X00-000 <Insert all applicable aircraft tail numbers like A34-001 through to A34-004
3. Aircraft manufacturer / Type
Manufacturer name / Aircraft type <For example, British Aerospace / A27 Hawk Mk127> / 4. Manufacturer Serial number/s and Tail number/s
<Use annex A for a large number of aircraft, otherwise list the manufacturer serial numbers and tail numbers here.>
5. Purpose <Purpose in accordance with DASR 21.A.701(a)
6. Aircraft configuration
The above aircraft for which a MPTF is requested is defined in <add reference to the document(s) identifying the configuration of the aircraft>
<For change(s) affecting the initial approval form, this form must be re-issued with description of change(s).
7. Substantiations
<Provide references to the document(s) justifying that the aircraft (as described in Block 6.) can perform the intended flight(s) safely under the defined conditions or restrictions.>
<For change(s) affecting the initial approval form, this form must be re-issued with reference(s) to additional substantiation(s).>
8. Proposed Flight Conditions / Restrictions
The above aircraft must be used with the following conditions or restrictions:
<Details of these conditions/restrictions, or reference to relevant document, including specific maintenance instructions and conditions to perform these instructions.>
9. Statement
The flight conditions have been established and justified in accordance with DASR 21.A.708.
The aircraft as defined in Block 6 of this form has no features and characteristics making it unsafe for the intended operation under the identified conditions and restrictions. Therefore I declare the aircraft is capable of safe flight.
<strikethrough what is not applicable>
10. (a) Approved under the privilege of MDOA ref: <when privilege of DASR 21.A.263(c)(6) applies>
10. (b) Approved under the privilege of MPOA ref: <when privilege of DASR 21.A.163(e)(6) applies
11. Date of approval: / 12. Authorised signature:
Name> <Position>
Annex A: Applicable manufacturer serial numbers <Use of annex is optional: may be useful for listing a large number of aircraft otherwise list the manufacture serial number/s in Section 4 of this form.>
DASR Form 18b – V3.0
ID: AH6165307
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Defence Aviation Safety Authority / DASR Form 20aMilitary Permit to Fly
APPLICABLE MANUFACTURER SERIAL NUMBERS
Manufacturer Serial Number / Tail Number000 / X00-000
DASR Form 20a - V0.1 Annex A
ID: AH6102290 Page 2 of 2