/

FCL.200 – 235 / FCL.205.A- FCL.210.A

/ LF-100

Private Pilot PPL(A)

Application for licence issue (Part-FCL)

/ Date: / 01.07.13
Issue: / 3.1

A – Supporting documents– The following shall be attached to the application markin the appropriate box.

Course completion certificates / Valid medical certificate / Proof of language proficiency
Logbook (filled & signed) / Skill test & theoretical exams / Passport photo and ID (copy)

B – Applicant details

Full name / Date of Birth
Permanent address and postcode / Licence No
Training organisation (ATO) / E-mail address / Telephone/mobile
Sd

C – Ratings applied for

SEP(A) / Night rating (FCL.810) / Other ratings:

D – Flying experience - Ref: FCL.210.A

1. Dual flight instruction (min 25) / = Hrs:
2. Supervised solo flight time (min 10) / = Hrs:
3. Cross-country flight time (min 5) / Confirmed
4. Instruction in FSTD / = Hrs:
5. Other A/C categories (crediting of flight time) (max 10 hrs.) / helic. sailpl./TMG
6 Total flight time (min 45) / = Hrs::

E – Verification of cross-country flight, ref. FCL.210.A (a)(2)

Date. / From/to:
Fullstop landings(where) / Distance (min 270 km)

F–signature

I, the applicant, hereby declare that I do not hold or have applied for the privileges applied for on this application in another member state, nor have I had my privileges revoked or suspended in another member state. I confirm that information given on this form is correct and that I have not withheld any relevant information or made any misleading statements. I understand that, if I have made any false or misleading statements in connection with this application, the licensing authority may refuse to grant me or may revoke privileges applied for or already held, without prejudice to any other action applicable under national law.

The ATO confirms thatit considers the applicant qualified to hold the privileges applied for.

Date: Place:
ATO signature (instructor) / Applicant signature

Instructions

Items A -F shall be filled in by student in consultation with instructor, including information on flight hours. All supporting documents must be attached otherwise the application will not be processed. The application should be clear and legible.

(A):Confirm that all supporting documents are attached

(C):All ratings shall be confirmed by course completion certificate

(D): Enter information on flight hours in consultation with instructor

(E):Enter information regarding cross-country flight in consultation with instructor

(F):Application shall be signed by applicant and instructor

Delivery:

Provided that all documents are in order and conditions are fulfilled the ITA estimates that the licence should be ready within three working days after the application was filed.

ITA use:

a – Almennt / B –Prófgögn / +/- / C- Flugstundir / +/-
Öll fylgigögn / Verklegu flugprófi ) lokið og prófgögn í lagi / Fullnægjandi reynsla
Umsækjandi a.m.k 17 ára / Bóklegu einkaflugmannsprófi lokið og prófgögn í lagi / Yfirlandsflug í lagi
Undirskriftir
Gilt heilbrigðisvottorð / 1.fl 2.fl
Athugasemdir
Móttekið dags: / Dagsetning afgreiðslu / Samþykkt / Undirskrift
Já Nei

Samgöngustofa – Icelandic Transport Authority –