Form CAA24065/01 "Application for Issue of Air Traffic Service Licence or Prime Rating - Pel Civil Aviation Authority" - Mongolia

Form CAA24065/01 is a Mongolia Civil Aviation Authority form also known as the "Application For Issue Of Air Traffic Service Licence Or Prime Rating - Pel Civil Aviation Authority". The latest edition of the form was released in February 1, 2016 and is available for digital filing.

Download an up-to-date Form CAA24065/01 in PDF-format down below or look it up on the Mongolia Civil Aviation Authority Forms website.

ADVERTISEMENT
ADVERTISEMENT

Download Form CAA24065/01 "Application for Issue of Air Traffic Service Licence or Prime Rating - Pel Civil Aviation Authority" - Mongolia

Download PDF

Fill PDF online

Rate (4.3 / 5) 61 votes
Print Form
Application for Issue of Air Traffic Service
Licence or Prime Rating
Applicant’s Specimen Signature
A completed Fit and Proper Person Questionnaire, form
CAA 24FPP
or CAA 24FPPDEC, is required with this
application. Refer to the 24FPP form for guidance on the appropriate form to be used.
1. Personal Details
MCAA Client / Licence Number
Date of Birth
(if known)
(DD-MMM-YYYY)
Surname
Title
(Mr/Mrs/Ms/Miss )
Given Name(s)
Country of Birth
Nationality
Address for Service
-
A
pplicants have to provide an address for service in Mongolia (i.e. a physical address) and to promptly notify the
Director of any changes.
Tel
Mob
Fax
Email
Postal Address
(if different from Address for Service)
Tel
Mob
Fax
Email
2. Licence Applied For
Please tick
Flight Service Trainee Licence (FSTL)
Air Traffic Trainee Licence (ATTL)
appropriate box.
Flight Service Operator Licence (FSOL)
Air Traffic Controller Licence (ATCL)
3. Rating Applied For
Please tick
Air Traffic Service Instructor Rating (ATIR)
Air Traffic Service Examiner Rating
appropriate box.
(ATER)
CAA USE ONLY
Receipt No.
Receipt Date
W/R No.
CAA 24065/01
Page 1 of 2
Rev 1 : Feb 2016 (NZ Rev 9)
Print Form
Application for Issue of Air Traffic Service
Licence or Prime Rating
Applicant’s Specimen Signature
A completed Fit and Proper Person Questionnaire, form
CAA 24FPP
or CAA 24FPPDEC, is required with this
application. Refer to the 24FPP form for guidance on the appropriate form to be used.
1. Personal Details
MCAA Client / Licence Number
Date of Birth
(if known)
(DD-MMM-YYYY)
Surname
Title
(Mr/Mrs/Ms/Miss )
Given Name(s)
Country of Birth
Nationality
Address for Service
-
A
pplicants have to provide an address for service in Mongolia (i.e. a physical address) and to promptly notify the
Director of any changes.
Tel
Mob
Fax
Email
Postal Address
(if different from Address for Service)
Tel
Mob
Fax
Email
2. Licence Applied For
Please tick
Flight Service Trainee Licence (FSTL)
Air Traffic Trainee Licence (ATTL)
appropriate box.
Flight Service Operator Licence (FSOL)
Air Traffic Controller Licence (ATCL)
3. Rating Applied For
Please tick
Air Traffic Service Instructor Rating (ATIR)
Air Traffic Service Examiner Rating
appropriate box.
(ATER)
CAA USE ONLY
Receipt No.
Receipt Date
W/R No.
CAA 24065/01
Page 1 of 2
Rev 1 : Feb 2016 (NZ Rev 9)
Name
CAA ID
4. Documents Required
For Licence Issue – FSTL, FSOL, ATTL & ATCL
Where required, enclose
photocopies of the
Completed Competency Test Report or
Exam Credits
following items.
ATS Licensing & Rating application form.
(FSOL & ATCL only)
(
FSOL & ATCL only)
Please tick to indicate
items enclosed.
Current Medical Certificate
Flight Radio Telephone Operator Rating
Note: When making
Evidence that required training has been
Aviation English Language Proficiency
application for a FSOL,
satisfactorily completed at either a Part
Assessment Credit
ATCL, ATS Instructor or
141 or Part 172 organisation
(FSOL & ATCL only)
ATS Examiner, include
FSTL or FSOL or ATCL
Aviation English Language Proficiency Assessment Credit - refer to CAA website and AC65.1 for further
or ATTL document with
info. -
Link to information on CAA web site
and
Link to AC65-1
the above items.
For ATS Instructor and Examiner Ratings
Completed Competency Test Report
Proof of experience
Evidence that required instructor/examiner training has been satisfactorily completed at either a
Part 141 or a Part 172 organisation
5. Fees
Fees:
Visa
Mastercard
Expiry Date
/
ATTL & FSTL
Name on Card
ATCL & FSOL
ATIR & ATER
Card Number
Please complete fee total box(es). Unless
the full fees are paid, applications will not
Licence Issue Fee
be processed. DO NOT SEND CASH.
Please fill in credit card details.
Rating Issue Fee
ATS Instructor or
Examiner Rating Fee
6. Declaration
I declare that to the best of my knowledge and belief the statements made and the information supplied in
this application and the attachments are complete and correct.
Consent to Disclosure & Collection
The provision of false
information or failure to
I authorise the collection by the Director of Civil Aviation or his delegate (hereinafter referred to as "the
disclose information
Director") from, and the disclosure to the Director by, any person, organisation or government department
relevant to the grant or
of any details of my knowledge & compliance with transport safety regulatory requirements.
holding of an aviation
document constitutes an
I authorise the Director to use, and disclose, the information obtained about me for any purpose under the
offence under the Civil
Civil Aviation Act, or other such purpose permitted by law.
Aviation Act.
Applicant’s
Date
Signature
7. Applicant’s Check List
Please ensure all
1. All applicable documents required in section 4.
documents are
enclosed.
2. Fee
3. Name and ID completed at top of page 2
Applications which are
incomplete or lacking
4. Specimen Signature at top of page 1
any required documents
will be returned.
5. Fit and Proper Person Questionnaire – either 24FPP or 24FPPDEC
PEL.
Civil Aviation Authority, P.O - 34, Box - 6, Ulaanbaatar 17120, Mongolia
Post this form to:
CAA 24065/01
Page 2 of 2
Rev 1 : Feb 2016 (NZ Rev 9)
Page of 2