Details flight information service officer or aeronautical station operator / applicant
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n FISO n ASOPrivileges 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):|
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Details assessor
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Attachments
- Copy of the assessment form according to the "Regeling opleiding en handhaving vakbekwaamheid bedieners van een luchtvaartstation en vluchtinformatievertrekkers", article 4, article 29 under c and article 31 under b.
- Application form for flight information service officers and aeronautical station operators.
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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 endorsement(s) (ICAO
location indicator, or airport name if not available)
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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
Declaration
For temporary permission to act as flight information service officer or aeronautical station operator
This declaration can be used as a temporary permission to act as flight information service officer or aeronautical station operator to exercise the privileges of the ratings and/or endorsements in accordance with article 22d of the "Besluit bewijzen van bevoegdheid voor de luchtvaart".
This declaration can only be signed by an assessor authorised under the "Besluit bewijzen van bevoegdheid voor de luchtvaart" 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 flight information service officer or aeronautical station operator/
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 flight information service officers and aeronautical station operators", to KIWA at P.O. Box 4, 2280 AB Rijswijk.
More information
(+31) (0)88 489 00 00 | www.ilent.nl
ILT.323.03 | 1 of 2
Validity
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(This temporary declaration is valid for a maximum period of eight weeks after successful completion of the applicable assessment.
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Flight information service officer or aeronautical station operator/applicant: Assessor:
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5.1 Date of assessment
5.2 Valid until
5.3 Signatures
Declaration
For temporary permission to act as flight information service officer or aeronautical station operator Human Environment and Transport Inspectorate Ministry of Infrastructure and Water ManagementILT.323.03 | 2 of 2
