CIVIL AVIATION AUTHORITY CZECH REPUBLIC

APPLICATION FOR CONVERSION OF A FOREIGN PILOT LICENCE

podatelna@caa.cz / v8gaaz5 / Úřad pro civilní letectví, K letišti 1149/23, 160 08 Praha 6

Part A: Personal data:

Name and surname:
Date and place of birth:
Address:
E-mail:	mobile:
Identity card number (Czech citizens):	Passport number (foreign nationals):

Part B: I am a holder of this pilot licence:

Type and Number of the original license:
State and date of the original license issue:
I apply for conversion of the following ratings included in my pilots licence:
1.	Valid till:	2.	Valid till:
3.	Valid till:	4.	Valid till:
Total flight time (in the relevant aircraft category):
Instrument flight time as PIC after the rating issue:

Part C: Enclosures to the application (originals, CAA will make verified copies):

1. Passport (foreign nationals) or identity card (Czech citizens) 2. Proof of permanent residency in Czechia 3. ICAO pilot licence 4. Log book (copy of the page showing the totals of flight hours and other important data, as applicable) 5. Medical Certificate 6. ZLP-F-168-10 Consent with the change of information

Part D: I apply for issue of a Czech pilot licence and following ratings:

Type of pilot licence:
Fill in all the requested ratings including the present experience:
ICAO English level: valid till:
English proficient – Last Flight Review in English during which t the two-way R/T communication was performed in English: Date:
Date and signature of Applicant: