RADIO STATION SURVEY

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FORM: AC-AWS019

November 2008

Aircraft Radio station Approval Request form

Approval issue/renewal of the following Aircraft Radio Station is required

AIRCRAFT REGISTRATION MARK / 5H- / AIRCRAFT TYPE:
OWNER’S NAME AND ADDRESS
AIRCRAFT MAY BE INSPECTED AT:
Radio Equipment fitted in an aircraft (indicate Type and model)
1 / H.F. No: 1 / Power Output
2 / H.F. No: 2 / Power Output
3 / V.H.F No: 1 / Power Output
4 / V.H.F No: 2 / Power Output
5 / ADF No: 1 / ADF No: 2
6 / ADF Loop No: 1 / ADF Loop No: 2
7 / VOR No: 1 / VOR No: 2
8 / DME No: 1 / DME No: 2
9 / Transponder No: 1 / Transponder No: 2
10 / ILS Loc No: 1 / ILS Loc No: 2
11 / ILS G/S No: 1 / ILS G/S No: 2
12 / ILS Mkr No: 1 / ILS Mkr No: 2
13 / Intercom system: / GPS:
14 / P.A. System: / EGPWS/GPWS
15 / Weather Radar No: 1 / Weather Radar No: 2
16 / Radar Altimeter: / TCAS/ACAS
17 / PAX Entertainment System: / ELT
The following additions/alterations/modifications to the equipment have been made since last approved:
The Aircraft Radio station has been serviced/maintained by me and is satisfactory in every respect:
Signature of A/c Radio Maintenance Engineer:
Engineer’s License No / Date:
I Certify that the Aircraft station was flight tested by me and is satisfactory in every respects:
Signature of Pilot
Pilot’s License No: / Date:
For T.C.A.A. use only:
The above Aircraft Radio station has been inspected by me and is approved/not approved* for the following reason(s):
Signed ……………………………. Date………………………………
Actioned. ------Date ……………………………….

Note: Please record serial numbers of the installed radio equipment at the time of inspection on the back of this paper.

Indicate Serial Numbers of installed equipment (main):

1 / H.F. No: 1 / Power Output
2 / H.F. No: 2 / Power Output
3 / V.H.F No: 1 / Power Output
4 / V.H.F No: 2 / Power Output
5 / ADF No: 1 / ADF No: 2
6 / ADF Loop No: 1 / ADF Loop No: 2
7 / VOR No: 1 / VOR No: 2
8 / DME No: 1 / DME No: 2
9 / Transponder No: 1 / Transponder No: 2
10 / ILS Loc No: 1 / ILS Loc No: 2
11 / ILS G/S No: 1 / ILS G/S No: 2
12 / ILS Mkr No: 1 / ILS Mkr No: 2
13 / Intercom system: / GPS:
14 / P.A. System: / GPWS
15 / Weather Radar No: 1 / Weather Radar No: 2
16 / Radar Altimeter: / TCAS/ACAS
17 / PAX Entertainment System:

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FORM: AC-AWS019 November 2008