Issue 1 l 1 of 2
This form shall be used by a qualified examiner to report the result of an instructor assessment of competence (AoC).
Designation of an examiner for the assessment of competence for the first issue of a flight- instructor (FI) certificate may only be arranged by the CAA-NL. All others may be arranged by either the CAA-NL an ATO or a DTO.
Incomplete or incorrectly filled out forms (including absence of additional documents) will not be processed.
Report
SPL Instructor assessment of competence for FI
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 (SPL) 1.3 Date of birth 1.4 Address
1.5 Postcode and place of residence 1.6 Telephone and e-mail address
1.7 Holder of / applicant for
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FI(S) (initial issue – SFCL.345)□
FI(S) (recency – SFCL.360)2 Details assessment of competence
2.1 Assessment of competence
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Initial issue□
Recency (SFCL.360)3 Evaluation of applicant (See Flight Test schedule FI/CRI/IRI/RFI)
3.1 Result per section
(+ = passed, - = failed) 1 2 3 4 5 6 3.2 Result of the assessment of
competence
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Pass□
Partial pass□
Fail 3.3 Reason of fail3.4 Remarks
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Issue 1 l 2 of 2
4 Details of the flight session(s)
4.1 Date
4.2 Sailplane/powered sailplane/TMG 4.3 Aircraft registration 4.4 Aerodrome or site and flight
time Aerodrome or site: Take-off time: Landing time: Flight time:
Total flight time:
4.5 Number of landings
5 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.
> I declare that all information on this form is completely and truthfully.
5.1 Name applicant 5.2 Date and place 5.3 Signature
6 Signing examiner
> Undersigned examiner certifies that all requirements regarding the issue, revalidation or renewal of this licence or rating or certificate 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.
6.1 Name examiner
6.2 Certificate number examiner 6.3 SPL number examiner 6.4 Date and place 6.5 Signature(s)
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