Form SRG1426 "Air Traffic Controllers Licence - Notification of the Revalidation or Renewal of an English Language Proficiency Endorsement" - United Kingdom

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Air Traffic Controllers Licence - Notification of the Revalidation or
Renewal of an English Language Proficiency Endorsement
(Regulation UK (EU) 2015/340)
Please complete this form online (preferred method) then print, sign and submit as instructed.
Alternatively, print, then complete in BLOCK CAPITALS using black or dark blue ink
FALSE REPRESENTATION STATEMENT
It is an offence under the UK Air Navigation Order to make, with intent to deceive, any false representation for the purpose
of procuring the grant, issue, renewal or variation of any certificate, licence, approval, permission or other document.
Persons doing so render themselves liable, on summary conviction, to a fine not exceeding the statutory maximum and on
conviction on indictment to an unlimited fine or imprisonment for a term not exceeding two years or both.
GUIDANCE NOTES
This form is to be used to notify the CAA of the completion of an assessment of English Language Proficiency for the
revalidation or renewal of an English Language Proficiency Endorsement contained in an Air Traffic Controller's
Licence.
English language proficiency endorsements are graded in accordance with the ICAO language proficiency rating scale
and are valid for the following periods:
Level four - 3 years, Level five - 6 years and Level six - 9 years.
Assessment for revalidation must take place within the 3 months before the expiry date. Where an endorsement has
been allowed to expire, an assessment will be required to renew the endorsement. The assessment can only be
conducted by organisations and individuals specifically authorised to do so by the CAA.
(Completed by the Applicant)
1. PERSONAL DETAILS (Complete as shown on passport)
Serial Number of ATCO Licence
Title................ Surname................................................... Forenames.................................................................
Date of Birth (dd/mm/yyyy).........................
Nationality.....................................................................
Place of Birth..................................................................Country of Birth..................................
...........................................
Applicants Address:
...................................................................................................................................................
.....................................................................................................................................................
.................................................................................................................................................
.
County...........................................Country..................................................Post Code.................
Home ............................................ Mobile ........................................................
elephone Numbers:
T
Email Address: ...............................................................................................
Unit Name
............................................................................................................................................
Unit Address
..................................................................................................................................................
.....................................................................................................................................................
County...........................................Country..................................................Post Code.................
CAO Location Indicator
The licence will be sent to the unit by default unless specified otherwise by the unit or individual with an explanation to:
ats.licensing@caa.co.uk.
Page 1 of 2
Form SRG 1426 Issue 3 October 2021
Air Traffic Controllers Licence - Notification of the Revalidation or
Renewal of an English Language Proficiency Endorsement
(Regulation UK (EU) 2015/340)
Please complete this form online (preferred method) then print, sign and submit as instructed.
Alternatively, print, then complete in BLOCK CAPITALS using black or dark blue ink
FALSE REPRESENTATION STATEMENT
It is an offence under the UK Air Navigation Order to make, with intent to deceive, any false representation for the purpose
of procuring the grant, issue, renewal or variation of any certificate, licence, approval, permission or other document.
Persons doing so render themselves liable, on summary conviction, to a fine not exceeding the statutory maximum and on
conviction on indictment to an unlimited fine or imprisonment for a term not exceeding two years or both.
GUIDANCE NOTES
This form is to be used to notify the CAA of the completion of an assessment of English Language Proficiency for the
revalidation or renewal of an English Language Proficiency Endorsement contained in an Air Traffic Controller's
Licence.
English language proficiency endorsements are graded in accordance with the ICAO language proficiency rating scale
and are valid for the following periods:
Level four - 3 years, Level five - 6 years and Level six - 9 years.
Assessment for revalidation must take place within the 3 months before the expiry date. Where an endorsement has
been allowed to expire, an assessment will be required to renew the endorsement. The assessment can only be
conducted by organisations and individuals specifically authorised to do so by the CAA.
(Completed by the Applicant)
1. PERSONAL DETAILS (Complete as shown on passport)
Serial Number of ATCO Licence
Title................ Surname................................................... Forenames.................................................................
Date of Birth (dd/mm/yyyy).........................
Nationality.....................................................................
Place of Birth..................................................................Country of Birth..................................
...........................................
Applicants Address:
...................................................................................................................................................
.....................................................................................................................................................
.................................................................................................................................................
.
County...........................................Country..................................................Post Code.................
Home ............................................ Mobile ........................................................
elephone Numbers:
T
Email Address: ...............................................................................................
Unit Name
............................................................................................................................................
Unit Address
..................................................................................................................................................
.....................................................................................................................................................
County...........................................Country..................................................Post Code.................
CAO Location Indicator
The licence will be sent to the unit by default unless specified otherwise by the unit or individual with an explanation to:
ats.licensing@caa.co.uk.
Page 1 of 2
Form SRG 1426 Issue 3 October 2021
2. ENGLISH LANGUAGE PROFICIENCY ENDORSEMENT - CURRENT DETAILS
Proficiency Level Indicated on current Licence ...................................................
Expiry Date shown on current Licence ...............................................................
3. ASSESMENT OF ENGLISH LANGUAGE PROFICENCY
Date Assessment carried out ..........................
Assessment carried out by: Name...................................................
Name and Location of Organisation...........................................................
Result of Assessment. (Proficiency level awarded in accordance with the ICAO Language Proficiency Scale.................
4. DECLARATION (tick as appropriate)
confirm that the above Air Traffic Controller was assessed for English Language Proficiency in accordance with
I
the process approved by the CAA and the above information is correct and complete.
Position .................................................................................
Name ........................................................................
Organisation.......................................................................
Signature .........................................................................
Date .........................
5. SUBMISSION INSTRUCTIONS
Please check:
• All Sections relevant to the application have been completed;
• The declaration has been signed by the English Language Proficency Assessor
When completed, return this form to:
Civil Aviation Authority
Aviation House
Beehive Ring Road
Crawley
West Sussex
RH6 0YR
or e-mail to: ats.licensing@caa.co.uk
Telephone Enquiries: +44 (0)330 022 1972
Page 2 of 2
Form SRG 1426 Issue 3 October 2021
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