Ac Form 8060-71 - Verification Of Authenticity Of Foreign License, Rating, And Medical Certification Page 3

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DEPARTMENT OF TRANSPORTATION
FEDERAL AVIATION ADMINISTRATION
Form Approved OMB No: 2120-0724
Expires, January 31, 2011
Verification of Authenticity of Foreign License, Rating, and Medical Certification
Basic Airman Information
1. Name as it appears on your foreign license.
2. Date of Birth
3. Place of Birth
Last
First
Middle
Month
Day
Year
4. Address you want your copy of the verification letter mailed to.
5. City, State, Zip Code (Country if applicable)
6. Citizenship
Certificate or Rating Applied For on Basis of:
7. Foreign License
7a. Country
7b. Grade of License
7c. Number
Issued by
7d. Ratings (Enter all ratings that appear on your foreign license)
8. Is your foreign license under an order of revocation or suspension by the foreign country that issued your license?


Yes
No
9. Do you hold a Current Foreign
9a. Class of
9b. Date Issued
9c. Date Expired
9d. Name of Examiner
Medical Certificate or Endorsement?
Certificate


Yes
No
10. Please provide the U.S. certificate and rating you will be applying for:
11. Please provide the location of the Flight Standards District Office (FSDO) where you intend to make application. (Select FAA FSDO from
list provided. Please do not provide location of flight school, employer, or Airmen Certification Branch, AFS-760.)
Telephone number where you can be reached
EMAIL Address
Applicant’s Certification – I certify that all statements and answers provided by me on this application form are complete and true to the best
of my knowledge and I agree that they are to be considered as part of the basis for issuance of my FAA certificate to me. I authorize the
issuing CAA to provide all pertinent information to the FAA. I have also read and understand the Privacy Act statement that accompanies
this form.
Signature of Applicant
Date
Attachments Must Include All of the Following:



Copy of Foreign License
Copy of Medical License or Endorsement
Copy of English Transcription of
License (If Applicable)
AC Form 8060-71 (1/08)

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