Issue 1 l 1 of 2
This form must be used by examiners to report the skill test and proficiency check results for Sailplane licences.
Incomplete or incorrectly filled out forms will not be processed.
Report
SPL Skill test and proficiency check
Send this form, including the Flight Test Schedules to:
Inspectie Leefomgeving en Transport / Luchtvaart, Postbus 16191, 2500 BD Den Haag, The Netherlands or e-mailaddress: ILTDocumentManagement@ilent.nl
Additional information
088 489 00 00 | www.ilent.nl
1 Details applicant
1.1 Name
1.2 Licence number (if available) 1.3 Date of birth
1.4 Address
1.5 Postcode and place of residence 1.6 Telephone and e-mail address
2 Details skill test / proficiency check
2.1 Skill test for
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Issue of a SPL (SFCL.145)□
Extension SPL privileges to TMG (SFCL.150(b))□
Extension SPL privileges to sailplanes (SFCL.150 (e)) 2.2 Proficiency check for□
SPL – recency (SFCL.160)□
Sailplane cloud flying – recency (SFCL.215(f))2.3 Privileges
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Sailplane□
TMG2.4 Launch method(s) (for sailplane)
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Winch launch□
Self launch□
Aerotow launch□
Car launch□
Bungee launch 2.5 Result per section(+ = passed, - = failed) 1 2A 2B 2C 3 4 5 2.6 Result of the skill test /
proficiency test
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Pass□
Partial pass□
Fail 2.7 Reason of fail2.8 Remarks
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Issue 1 l 2 of 2
3 Details of the skill test / proficiency check flight
3.1 Date
3.2 Sailplane/powered sailplane/TMG 3.3 Aircraft registration 3.4 Aerodrome or site and flight
time Aerodrome or site: Take-off time: Landing time: Flight time:
Total flight time:
3.5 Number of landings
4 Signing applicant
> Undersigned applicant is aware of the consequences of providing incomplete, inaccurate or false information related to the issue, revalidation or renewal of this licence or rating as specified in ARA.FCL.250(a) and ARA.GEN.355 or applicable national legislation.
4.1 Name applicant 4.2 Date and place 4.3 Signature
5 Signing examiner
> Undersigned examiner certifies that all requirements regarding the issue, revalidation or renewal of this licence or rating have been fulfilled in accordance with Part-SFCL (SFCL.410(a)(2) and SFCL.410(b)(2)) or applicable national legislation.
> Undersigned examiner has received information from the applicant regarding their experience and instruction, and found that experience and instruction comply with the applicable requirements of Part-SFCL.
> Undersigned examiner confirms that all the required manoeuvres and exercises have been completed, unless specified otherwise above in the case of fail or partial pass
5.1 Name examiner
5.2 Certificate number examiner 5.3 SPL number examiner 5.4 Date and place 5.5 Signature(s)
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