EASA PART 66 APPROVED AIRCRAFT MAINTENANCETRAINING APPLICATION

MALAYSIAN INSTITUTE OF AVIATION TECHNOLOGY

Instructions:

~ Please fill the application in CAPITAL LETTERS.

~ Please tick (--II where applicable.

MonthYear

AERO·BILDUNGS GmbH

SECTION 1: PROGRAMME PREFERENCE *

CATEGORY B2D (AVIONICS)CATEGORY B1 D(MECHANICAL)

DB 1.1 : AEROPLANES TURBINEo B 1.2 : AEROPLANE PISTON

DB 1.3: HELICOPTER TURBINEo B 1.4 : HELICOPTER PISTON

SECTION 2: PERSONAL DETAILS

Full Name

Correspondence AddressI ~

1---------------------------- Postcode

State/Cou ntry

IC/Passport No. Nationality

Contact No. _________________ --11 Mobile No.

Gender: DMaie c::J Female

Race & Religion (For Malaysian only)

Age Date of Birth

Marital Status Email Address

Chronic Disease Code *Medical background: Disability Code *

SI;CTION 3: PARENT/GUARDIAN INFORMATION

Address Contact No.Full Name Relationship

Note (*): Please refer to guidelines given.

SECTION 4: QIJAUFICA. 10.. INFORMATION

SPM D SPMV D O'Level D Year

Subjects Grade Subjects

1 c::::J 5

2 c::::J 6

3 c::::J 7

4 c::::J 8

1====~I=====11......- 1

FOR MALAYSIAN APPLICANTS ONLY: SPM (July):

BAHASA MELAYU 1 BAHASA INGGERISI"--_---J MATHEMATICS 1 _

OTHER QUALIFICATIONS

Highest Qualification I Professional Lisence

Major I Specialization

University I Institute

D ·1""--_ Yes DNoC]CGPA Have you completed your studies?

WORKING EXPERIENCES* If applicable

YearDesignation Company

From To

Note (*): Five years prior to the applications

TI

I declare that the information given herein are complete and correct and the document copies are true.I understand that my application can be rejected in the event that my submission are incorrect,incomplete or false.

Applicant's Signature: Date:

2

CHECKLIST FOR APPLICANT

The following document must be submitted together with application form.

No Supporting document to be included I ( \j )

Certified true copy of* SPM / SPMV / Q'Level Certficate and

1 * STPM / A' Level Certificate or* Certficate / Diploma certificates with transcript/result slip of every semester

2 Certification Letter of Completion of Studies from previous institutions,If applicants still waiting for final result.

3 A copy of NRIC and Birth Certificates

* PLEASE SEND APPLICATION TO:

EASA Program.Malaysian Institute of Aviation TechnologyLot 2891, Jalan Jenderam Hulu, Jenderam Hulu, 43800, Dengkil, Selangor Darul Ehsan.MALAYSIA.

Fax: (603) 8768 7572/8485Tel: (603) 8768 8487/7588

GUIDELINES

SECTION 1:PROGRAMME PREFERENCEi) Programme offered by semester is subject to change

SECTION 2:MEDICAL BACKGROUND

Physical Disability

CODE DESCRIPTION00 No disability01 Blind02 Deaf obe ear/both03 Dumb04 Leg-Disability05 Hand-Disability06 Lonq/Short Siqhted07 Colour Blind08 Others

Chronic DeseaseCODE DESCRIPTION

00 No Chronic Desease01 Bladder Stone or Gall Stone, kolestisis02 High Blood03 Diabetes04 Desease regarding blood/brain vessel05 Cataract, ptegrium06 Tumor07 Cancer08 Hernia, Fistulate, Hydrocale09 Knee/Backbone problem10 Endometriosis11 Epilepsy12 Gastric13 Ulcer14 Eritematocus15 Prostate Glen16 Organ Disfunctional e.g Kidney17 Mental illness18 HIV19 Others