DCA (L) 54(A)

I hereby request that a Certificate of validation to my Foreign ………………………………………………………... Licence No. ………………. May be granted to me, and I certify the particulars given by me in this Form are true to the best of my knowledge and belief, Personal Flying Log book(s) and statuatory fees should accompany this form.

Date: ……………………………………….. Signature: …………………………………….

II: PERSONAL PARTICULARS OF APPLICANT:

1. Name in full: ……………………………………………………………………………………………

(Block Capitals, Surname First)

2. Title, Rank, Mr. Or Mrs., Miss etc. …………………………………………………………………….

Postal Address (if any) …………………………………………………………………………………

…………………………………………………………………………………………………………..

3. Nationality: ……………………………………………………………………………………………..
4. Date of Birth: …………………………………. Place of Birth: ………………………………………

 

III: EXPERIENCE/QUALIFICATIONS:

5. *Licence(s) held and country if of issue: ALTP/SCP/CPL/FL.NAV/FL.ENG.

…………………………………………………………………………………………………………..

Licence No: …………………………………… Date of Issue ……………………………………….

Country of Issue:………………………………

6. Validity Period of the Licence: …………………………………………………………………………
7. Date of the most recent medical examination: …………………………………………………………

8. Total Flying Experience To-date. P1 Day: …………………………………………………….

P.1.Night ………………………. P.2/3 Day …………………………. P.2/3 Night ………………….

9. * Total Flying Experience within the last six/twelve months: …………………………………………

10. Flight Radio Telephony Operator's Licence No. ……………………………………………………….