Form 4530 - Registration And Amendments Of Foreign Charter Operators Under Part 380 Of The Regulations Of The Department Of Transportation - U.s. Department Of Transportation Page 2

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9. Names, Addresses and Citizenship of Applicant’s President and Directors (use additional page, if necessary):
President:
(Name in Print)
(Address)
(Citizenship)
Director(s):
(Name in Print))
(Address)
(Citizenship)
(Name in Print)
(Address)
(Citizenship)
:
(Name in Print)
(Address)
(Citizenship)
(Name in Print)
(Address)
(Citizenship)
(Name in Print)
(Address)
(Citizenship)
(Name in Print)
(Address)
(Citizenship)
8. Check type or types of :services applicant intends
9. FOR USE IN REPORTING CHANGES OR AMENDMENIS TO INFORMATION PREVIOUSLY FILED.
to perform upon commencement of operations:
(b) Description of any other changes/amendments which
(a) Previously registered name and address:
are required to be reported by Section 297.24:
Foreign air transportation
Interstate air transportation
Overseas air transportation
10. Certification
I certify that the information contained in this application, and in the attachments hereto, is complete and accurate to the best of
my knowledge. I certify that all public charter operations performed by the registrant will be conducted in accordance with the
provisions of Part 380 of DOT’s Regulations (14 CFR 380) and that no flights will be advertised, sold, or operated unless and
until the registrant has entered into financial security Arrangements as prescribed in Part 380.
(Name in Print)
(Signature of Officer)
(Title)
(Date)
NOTE: Application must be signed by a responsible officer, such as the President, Vice President, Secretary, or Treasurer or Partner or Owner of
the applicant forwarder.
This document not acceptable if not dated.
The Department's approval of this registration application is based In part on effective reciprocity between the United States and the Registrant's
country of citizenship. If and when the Department of Transportation determines that effective reciprocity no longer exits, this registration Is null
and void.
OST Form 4530

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