/ LATVIJAS REPUBLIKA
CIVILĀS AVIĀCIJAS AĢENTŪRA
REPUBLIC OF LATVIA
CIVIL AVIATION AGENCY

Examiner Designation to Conduct ATPL Skill Test

  1. GENERAL INFORMATION

Applicant’s Name: / Surname:
Pilot licence No: / Operator:
A/C Type / Phone/Fax:
E-mail: / Skill Test date:
Proposed TRE: / /Name, Surname / Authorisation No:
  1. EXPERENCE REPORT FOR INITIAL ATPL ISSUE

  1. Applicant Age (JAR-FCL 1.265)min 21years
  2. JAA CPL licence or ICAO CPL/ATPL (JAR-FCL1.275(a))valid until:
  3. IR multi engine aeroplane(JAR-FCL1.275(a)(1))valid:
  4. MCC course(JAR-FCL 1.290)passed:
  5. JAR Medical class 1 (JAR-FCL 1.270)valid until:
  6. Theoretical examination JAA ATPL (JAR-FCL 1.285)passed:
  7. Flight experience (JAR-FCL 1.280(a))(min 1500 hr)hours:
of which FNTP and FS (JAR-FCL 1.280(a))(max 100 hr)FS hours:
of which FNTP(JAR-FCL 1.280(a)) (max 25 hr)FNTP hours:
including (JAR-FCL 1.280(a))
a)MPA experience on JAR 25/23 aeroplanes(min 500 hr)hours:
b)PICUS(min 500 hr)hours:
or PIC(min 250 hr)hours:
or PICUS(min 180 hr)PICUS hours:
and PIC (min 70 hr)PIC hours:
c)cross country experience(min 200 hr)hours:
of which PIC or PICUS(min 100 hr)hours:
d)instrument time(min 75 hr)hours:
of which instrument ground time(max30 hr)hours:
e)night flight time as PIC or CO-Pilot(min 100 hr)hours:
By this I certify that the above statements are correct and as required to conduct Skill Test for ATPL issue.
Name, Surname: / Position:
Signature: / Date:

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NOTE:
1.This completed form must be forwarded at least 10 days prior to proposed ATPL Skill Test to:
or , or faxed +371 67507903
or posted to Personnel Licensing Division,
Civil Aviation Agency,
Lidosta “Rīga” 10/1 Mārupes novads,
LV-1053,Latvija
2. Within 10 days the CAA of Latvia will designate examiner and send confirmation
to the e-mail of the Operator or Applicant.
3. To receive ATP licence the Applicant shall submit to the CAA of Latvia following
documents:
a) Passport copy;
b) Current Pilot Licence copy;
c) Class 1 JAA Medical Certificate copy;
d) ATPL Theoretical Knowledge Examination Results;
e) Filled in ATPL Skill Test form signed by examiner;
f) A copy of the relevant logbook pages (flight experience & STD pages);
g) Application Form to receive ATPL;
i) English Language Proficiency Certificate copy;
j) MCC course completion certificate copy.
  1. FOR CAA OF LATVIA USE ONLY

The CAA of Latvia designates TRE: / /Name, Surname
Authorization Number:
To conduct the Skill Test in SIM / A/C:
for ATP licence issue to applicant:
Permission No. for the Skill Test:
CAA inspector: / /Name, Surname
Signature: / Date:

1/2P.3.9.3.1./01