1. The operator

The operator is a private individual:
Ms Mr
Name: First name: / The operator is an organisation:
Name of the organisation:
Trading name:
Operator declared since 1 January 2016 - Operator number:
Undeclared operator with
permission to perform experiments
a specific authorisation (e.g. foreign operators)
Address
Number: Street: Place:
Post code: Post box: Cedex: Town:
Country:
Contact:
Ms MrName: First name: Function:
Mobile: e-mail: @
  1. Flight conditions

Particular activities
Experiments
  1. Requested prefectural exemption(s)

Exemption from the ban on night flights:
A / Particular activities in VISULA LINE OF SIGHT at NIGHT under the conditions of S1 or S3
B / Other cases of particular activities at NIGHT (in-sight flights under conditions other than those of scenarios S1 or S3, or out-of-sight flights)
C / Experiments at NIGHT
Exemptions from maximum heights:
D / Particular activities or experiments, BEYOND LINE OF SIGHT, with:
- an aircraft weighing more than 2kg and at a height greater than 50 m above the ground, or
- an aircraft weighing less than 2kg and at a height greater than 150 m above the ground.
E / VISUAL LINE OF SIGHT experiments at heights above 150 m
-Night time:
at latitudes between 30° and 60°, night time starts 30 minutes after sunset and ends 30 minutes before sunrise;
at latitudes equal to or lower than 30°, night time starts 15 minutes after sunset and ends 15 minutes before sunrise.
-- See the definition of “VLOS flightt” and “BVLOS flight” in article 2-2 of the “Airspace” Order.
-See the conditions of scenarios S1 and S3 in paragraph 1.3 of appendix III of the“Aircraft” Order.
-If the flights take place in a part of the airspace that allows for the segregation of remotely piloted aircraft and other users (e.g., Temporary Restriction Zones), exemptions A, B and C above are unnecessary and do not have to be requested (see article 3, item 4 of the Space Order).
-If the flights take place in a part of the airspace that allows for the segregation of remotely piloted aircraft and other users (e.g., Temporary Restriction Zones), exemptions D and E above are unnecessary and do not have to be requested (see articles 8-2 and 9-2 of the Space Order).

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  1. Date(s) of the flights

StartDate: Time: h min
(DD/MM/YYYY)(local time in 24h format)
EndDate: Time: h min
(DD/MM/YYYY)(local time in 24h format)
  1. The aircraft

1 / Constructor: Model: Serial N°:
Class: Captive aircraft: yes noMaximum planned weight for the flights: kg
2 / Constructor: Model: Serial N°:
Class: Captive aircraft: yes noMaximum planned weight for the flights: kg
3 / Constructor: Model: Serial N°:
Class: Captive aircraft: yes noMaximum planned weight for the flights: kg
4 / Constructor: Model: Serial N°:
Class: Captive aircraft: yes noMaximum planned weight for the flights: kg
  1. Description of the flights

Site n° 1
Outside populated areas In congested areas Close to a gathering of persons (please describe):
Post code / Town / Address
Latitude /  + (North)  - (South) , / Longitude /  + (East)  - (West) ,
(Enclose a map/diagram of the precise zone of use of the drone – See paragraph 7)
Aircraft that may be used: AllOtherwise, please specify: 1 2 3 4
Description of the flights: Maximum flying height: mMaximum distance of the remote pilot: m
In sight Out of sightMaximum flying speed: m/s
Controlled/regulated airspace that may be entered:
Purpose of the flights and substantiation of the need for an exemption:
Site n° 2
Outside populated areas In congested areas Close to a gathering of persons (please describe):
Post code / Town / Address
Latitude /  + (North)  - (South) , / Longitude /  + (East)  - (West) ,
(Enclose a map/diagram of the precise zone of use of the drone – See paragraph 7)
Aircraft that may be used: AllOtherwise, please specify: 1 2 3 4
Description of the flights: Maximum flying height: mMaximum distance of the remote pilot: m
In sight Out of sightMaximum flying speed: m/s
Controlled/regulated airspace that may be entered:
Purpose of the flights and substantiation of the need for an exemption:

Rest of the list of the sites in the appendix. Number of enclosed additional pages:

  1. Documents to be enclosed

The file contains the following documents:
-A copy of the acknowledgement of receipt of the declaration of activity, of the specific authorisation or of the permission (enclose these documents as soon as they are available, if they were unavailable when the initial request was made);
-Place/layout plan (aeronautical chart, photos or others);
-Precise zone where the drone will fly and position of the remote pilot and any third parties (map/diagrams, etc.);
-Night flights:
description of the means of lighting the drone and the zone where it flies;
where appropriate, a copy of the request for the creation of a Temporary Restriction Zone (ZRT) or a copy of the notification of its creation;
-Exemptions from maximum flying altitudes: a description of the precautions that will be taken to guarantee separation from other aircraft (air traffic control procedures, observers, means of lighting, etc.)
  1. Operator commitment

“I, the undersigned, representing the operator identified in paragraph 1 above,
do hereby certify the accuracy of the information in this declaration.
I hereby agree to:
  • meet all the regulatory requirements applicable to the planned operations;
  • refrain from using the aircraft under conditions where there would be a risk to other aircraft or persons or property on the ground, including in the event of a probable failure.
declare that an insurance policy has been taken out covering risks related to the operations.“
In: On:
(DD/MM/YYYY) / Name:
First name:
Function (organisations):
References:
[1] The so-called “Airspace” Order of 17/12/2015 pertaining to the use of airspace by unmanned aircraft.
The so-called “Aircraft” Order of 17/12/2015 pertaining to the design of unmanned civil aircraft, their conditions of use and the capabilities required of the persons who use them.
The exemption request must be sent to the regionally competent Prefect 30 days before the date of the operations, with copies to:
-the regionally competent DSAC IR, for requests limited to case A
-DSAC Headquarters at for requests including cases B to E
All files that are incomplete and/or late will be rejected.
Caution: This form only applies to exemptions from the restrictions on flying at night and/or above maximum altitudes. The operations described in this form may require other formalities and other authorisations, and in particular:
-A specific authorisation is required if the planned operations are performed in derogation of the operational scenarios S1 to S4 defined by the Aircraft Order. E.g.: foreign operators not declared in France, particular activities at night that do not meet the conditions of scenarios S1 to S4 (case B) or BVLOS flights with an aircraft weighing more than 2kg and at heights above 50m from the ground (case D).
-Permission is required for experiments
-A preliminary declaration must be made to the regionally competent Prefect for VLOS flights in populated areas (form CERFA 15476).
-Preliminary notification must be given of BVLOS flights or flights at altitudes above 50 m in training zones for military aircraft (form CERFA 15477).
-An agreement or a protocol with the local air traffic control department (or the aerodrome operator) for flights in controlled airspace or in the vicinity of an aerodrome (see articles 4-4, 4-5, 7-2, 8-3 and 9-3 of the Space Order).
For more information on unmanned aircraft, please refer to the Civil Aviation General Directorate:.

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