Confirmation Of Military Experience printable pdf download

Confirmation of Military Experience for Military Accreditation Scheme

(MAS) Credits in Accordance with Article 10 of Commission Regulation

(EU) 1178/2011

Please complete this form online (preferred method) then print, sign and submit as instructed.

Alternatively, print, then complete in BLOCK CAPITALS using black or dark blue ink.

Unique No. (to be completed by CAA)

Please read attached Guidance Notes before completing this form.

FALSE REPRESENTATION STATEMENT

It is an offence under Article 256 of the Air Navigation Order 2016 to make, with intent to deceive, any false

representation for the purpose of procuring the grant, issue, renewal or variation of any certificate, licence, approval,

permission or other document. This offence is punishable on summary conviction by a fine up to £5000, and on

conviction on indictment with an unlimited fine or up to two years imprisonment or both.

1. APPLICANT DETAILS

To be completed by the Applicant

CAA Personal reference number (if known):

Title: .............

Forename(s): ...................................................

Surname: ..................................................................

Date of birth (dd/mm/yyyy): .....................

Nationality: ..........................................................

Town of birth: .................................................................

Country of birth: ..................................................................

Permanent Address: ..........................................................................................................................................................

.........................................................................................................................

Postcode: ...........................................

Telephone: .........................................................

Alternative telephone Number: .......................................................

E-mail: ............................................................................

Fax Number: .......................................................................

A certified copy of your valid Passport, EEA/EU National Identity Card or Full EU Photographic Driving Licence (see

Guidance Note 1) must accompany your application as proof of identification.

2. ADDRESS FOR CORRESPONDENCE (if different from above)

To be completed by the Applicant

Postal Address: .................................................................................................................................................................

...........................................................................................................................................................................................

.........................................................................................................................

Postcode: ...........................................

3. SERVICE DETAILS

To be completed by the Applicant

Branch RN

Army

RAF

Service No.: ..............................................................................................

(for serving and former serving members of HM Armed Forces)

Currently serving Yes

if no, date of leaving UK Armed Forces: ...........................................................

Form SRG 2133 Issue 03 August 2016