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CAAM Borang 1 – AE – Pin 2/17

A – APPLICANT’S DETAILS To be completed by the applicant (tick appropriate box)

Application type: Initial Renewal

Organisation/Employer:

Applicant’s name: (Capital Letters)

Date of birth: (dd/mm/yy)

Nationality: MyKad/Passport:

Medical Certificate Class: Date of last Medical: (dd/mm/yy)

Date of Expiry: (dd/mm/yy)

Permanent Address:

Telephone Number: Mobile telephone:

E-mail:

B – FLIGHT CREW LICENSE DETAILS To be completed by the applicant (tick appropriate box)

Flying School Graduate: Flying Training School: Graduation Date: (dd/mm/yy)

Aircraft category: Aeroplane Helicopter Balloon ELPT Level: 4 5 6

Type of licence: ATPL CPL PPL BPL Licence/AE* No:

Aircraft type rating SE ME IR FSTD:

Last PPC issue date: (dd/mm/yy)

Type rating: AE Name/ AE No:

Applied License Endorsement:

Logbook Hours

Total PIC SIC Solo Solo x-country

Total x-country

Instrument Simulated Instrument

PIC Night

Total Night

Flight Instruction

Aeroplane

Helicopter

Balloon

C – DECLARATION OF APPLICANT To be completed by the applicant

I hereby confirm my compliance with the FCL.1010 and FCL.1030 of the FOD – FCL and declare that the information provided on this form is correct. I enclose payment for the charges payable on application in accordance with the Civil Aviation (Fees and Charges) Regulations 2016. I agree to pay any additional charges which may become payable in respect of this application under Civil Aviation (Fees and Charges) Regulations 2016. Please note that failure to submit all of the required documentation and information will lead to a delay in processing your application. Applicant’s Signature:

Date: (dd/mm/yy)

AUTHORISED EXAMINER (AE)

APPLICATION FORM

Initial / Renewal

Flight Examiner

Type Rating Examiner

Instrument Rating Examiner

Flight Simulator Examiner

Flight Instructor Examiner

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D – DECLARATION BY ORGANISATION/EMPLOYER To be completed by the HOT/DFO/FOM

I hereby declare that the above details submitted by _________________________________________________________________________ are true in every respect and meet all the requirements as stipulated by FCL.1010 and FCL.1030 of the FOD – FCL.

Name of HOT/DFO/FOM

(Capital Letters)

Signature & Stamp:

Date: (dd/mm/yy)

E – AUTHORISED EXAMINER CHECKLIST To be completed by the FOI

Ser. Item For CAAM use only

1. AE prerequisite, minimum hours and specific requirements are as stipulated by FOD – FCL (initial).

2. Hold a license & rating at least equal to the license & rating for which he will be issued an AE certificate.

3. Hold appropriate instructor rating for which he will be issued an AE/TRE/SFE certificate and/or the IOS certificate (if applicable). Copy of the instructor/IOS certificate is required (initial).

4. Qualified to act as PIC of the aircraft during flight check, if manipulating the flight controls.

5. Attended and passed the AE Ground Course (initial) or AE Refresher seminar (renewal) conducted by the CAAM. Copy of the AE Ground Course/Seminar certificate is required.

6. For renewal, copy of 2 x skill test per year and copy of 6 x IR test per year. One of the skill tests during the final year of validity period shall be assessed by the CAAM FOI.

7. Original and copy of the Logbook (relevant pages).

8. Original and copy of the license (all pages).

9. Copy of two consecutive previous PPC/OPC Check report (the applicant).

10. Application fees – > 5700 kg (RM200), < 5700 kg (RM100), plus other type (RM50).

11. Two colour photo passport size (name of applicant at the back of the photo – initial).

F – FOR CAAM OFFICIAL USE ONLY To be filled by the FOI

I certify that the applicant meet/does not meet* all the requirement as stated in the application form for the applicant of FE / TRE / IRE / FSE / FIE * (*strike as necessary) Tick appropriate box Initial Renewal I nominate the CAAM FOI __________________________________________________________________________________ to conduct the Ground and Flight/Simulator Observation session.

Name of FOI: (Capital Letters)

Signature & Stamp:

Date: (dd/mm/yy)

REMARKS BY DIRECTOR OF FLIGHT OPERATIONS (if any)

Name of DFO: (Capital Letters)

Signature & Stamp:

Date: (dd/mm/yy)

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FOR CAAM OFFICIAL USE ONLY

Information Checked _________________________________________________________ Application Fee:

ACCEPT: Receipt No:

REJECT: _________________________________________________________ Cheque/P.O:

FOI Signature:

_________________________________________________________

Initial:

Date: _________________________________________________________ Date:

END

NOTE:

The application is to be filled out by typing or writing clearly in capital letters:

(A), (B) & (C) The applicant shall complete this section. (D) The HOT/DFO/FOM shall complete this section. (E) The AE application checklist as reference and shall be ticked by the CAAM FOI. (F) The CAAM FOI shall certify whether the applicant meet or does not meet the requirement for an AE application and nominate the FOI for the Ground and

Flight/Simulator session. The DFO shall put his remarks if any.