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P.O. Box 17, Safat 13001, Kuwait

State of Kuwait

Tel. (965) 2474-3940

Fax (965) 2476-5796

Directorate General of Civil Aviation

SITA: KWIASYA

Email: safety@dgca.gov.kw

Aviation Safety Department

Surname .................................................................................

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



Examiner Licence number: ........................................

Chair

Supernumerary

Signature: ...............................................

Surname .................................................................................

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



Examiner Licence number: ........................................

Chair

Supernumerary

Signature: ...............................................

Where an examination was not completed on the dates planned, please tick the appropriate box and return to ASD at the address on

page 4.



Unit Endorsement Exam postponed – alternative date to be arranged with ASD and new form DGCA/ATS/503 to be submitted



Unit Endorsement Exam cancelled – no alternative date will be arranged

Signed .............................................................................................

SECTION 5) ENGLISH LANAGUAGE PROFICIENCY ENDORSEMENT

This section is to be completed for the initial award of the English Language Proficiency Endorsement.

The English Language Proficiency of the applicant has been assessed in accordance with Unit procedures.

The applicant has been assessed against the ICAO language proficiency rating scale and has been assessed to have proficiency in the

English Language at the following level (delete as applicable):



Level 6 (Expert Level)



Level 5 (Extended Level)



Level 4 (Operational Level)

The assessment was carried out on (dd/mm/yyyy): ..................................................................................................................................

Assessment conducted by

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

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

Examiner Licence Number: .........................................................

Signature: ........................................................................................

SECTION 6) CANCELLATION OF UNIT ENDORSEMENT

(Complete only if Unit Endorsement has expired or been withdrawn)

Rating/Rating Endorsement/Sector/Operational Position (e.g. ADI/TWR/RAD/GMS/XXXX Tower) Date expired/withdrawn (dd/mm/yyyy)

……………………………………………………………………………………………………………… ……………………………………………

False Statement

The making of false statement for the purpose of procuring the issue of a certificate of registration is an offence under the Act 60 of

1960. The Directorate General of Civil Aviation may, in any case in which they think it is desirable, require the applicant for a certificate

of registration to furnish such evidence as they may desire and to make and subscribe a statutory declaration as to the truth of the

facts set out in the application.

SECTION 7) DECLARATION BY APPLICANT

I hereby declare that I have carefully considered the statements made and that to the best of my belief they are correct.

Signature: ........................................................................................................................

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

DECLARATION BY TRAINING ORGANISATION/AERODROME AUTHORITY/ATC CENTRE AUTHORITY

Form No: 1317

Page 3 of 4

28 April 2016 v0.1

Form No: 1317 - Air Traffic Controller Licence - State Of Kuwait Directorate General Of Civil Aviation Page 3

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