Details (student) air traffic controller / applicant
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n Student ATCO n ATCOPrivileges issued
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The assessor confirms, that the candidate has fulfilled all applicable requirements for the issue of a temporary permission for the following rating and/or endorsement(s):|
n EHAA n EHAM n EHBK n EHGG n EHRD n EHLE
Details assessor
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Attachments
- Copy of the assessment form according to ATCO.B.020(g), ATCO.C.015 (c), ATCO.C.055 (b), ATCO.D.035(e) or ATCO.D.70(a)
- Application form for air traffic controllers
Validity
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(This temporary declaration is valid for a maximum period of eight weeks after successful completion of the applicable assessment or eight weeks after the expiry date of the unit endorsement in case of renewal of the unit endorsement.
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(Student) air traffic controller/applicant: Assesor:
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1.1 Last name and first name 1.2 Date of birth
1.3 Licence number (if applicable) and type
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2.1 Rating and/or endorsement(s) 2.2 Unit endorsements (None in case
of Student ATCO)
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3.1 Last name and first name 3.2 Licence number
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4.1 The applicant must send the following attachments with this declaration
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5.1 Date of assessment (or expiry date in case of renewal unit endorsement)
5.2 Valid until
5.3 Signatures
Declaration
For temporary permission to act as (student) air traffic controller
This declaration can be used as a temporary permission to act as (student) air traffic controller to exercise the privileges of the ratings and/or endorsements in accordance with Article 2 paragraph 3(b) of the Basic Regulation (EC No. 216/2008) and (AMC1) ATCO.AR.D.001(a) of (EU) No. 2015/340.
This declaration can only be signed by an assessor authorised under Part-ATCO holding a licence issued by the Dutch Competent Authority This declaration cannot be used for the issue of a licence.
Incomplete or incorrectly completed forms will not be processed.
The (student) air traffic controller/applicant must keep the original filled out and signed form.
The applicant must send a copy of this form, as part of the "application form for air traffic controllers", to KIWA at P.O. Box 4, 2280 AB Rijswijk.
More information
(+31) (0)88 489 00 00 | www.ilent.nl
ILT.296.06 | 1 of 1
