CIVIL AVIATION AUTHORITY CZECH REPUBLIC

APPLICATION FOR VALIDATION OF PILOT LICENCE FOR SPECIFIC TASKS OF LIMITED DURATION – MANUFACTURER FLIGHTS

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 validation of the following ratings included in my pilots licence:
1.	Valid till:	2.	Valid till:

Part C: Enclosures to the application (copies):

1. Passport (foreign nationals) or identity card (Czech citizens) 2. Pilot licence 3. Medical Certificate 4. Confirmation that applicant is employed, directly or indirectly, by an aircraft manufacturer or by an aviation authority – must contain specific task description 5. ZLP-F-168-10 Consent with the change of information

Part D: I apply for validation of my pilot licence for specific tasks - MANUFACTURER FLIGHTS - on Czech-registered aircrafts:

Aircraft registration mark:
Flights will be carried out from the date: to the date:
Specific task:
Flight instruction and testing for initial issue of type ratings
Supervision of initial line flying by the operators’ pilots
Delivery or ferry flights
Initial line flying
Flight demonstrations or test flights
Date and signature of Applicant:

Part E: Fee:

1.000,- CZK for an applicant from EU states, European Community and Switzerland 3.000,- CZK for an applicant from other states Account No: 3711-3727061 / 0710 Variable symbol: on request IBAN: CZ48 0710 0037 1100 0372 7061 SWIFT: CNBACZPP