CIVIL AVIATION AUTHORITY CZECH REPUBLIC

APPLICATION FOR VALIDATION OF PILOT LICENCE FOR SPECIFIC TASKS OF LIMITED DURATION – SPECIFIC NON-COMMERCIAL TASKS

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. Log book (copy of the page showing that applicant has completed at least one acclimatisation flight with a qualified instructor) 4. Medical Certificate 5. ZLP-F-168-10 Consent with the change of information

Part D: I apply for validation of my pilot licence for specific tasks - SPECIFIC NON-COMMERCIAL TASKS - on Czech-registered aircrafts:

Aircraft registration mark:
Specify non-commercial task to be carried out:
Flights will be carried out from the date:	to the date:
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