Form Srg 1411a - Application For The Initial Issue Of An Air Traffic Controller (Atco) Licence Page 2

Download a blank fillable Form Srg 1411a - Application For The Initial Issue Of An Air Traffic Controller (Atco) Licence in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Srg 1411a - Application For The Initial Issue Of An Air Traffic Controller (Atco) Licence with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

3. RATING/ENDORSEMENT TO BE ASSESSED (CONTINUED):

Unit Endorsement Sector/Position(s) (if appropriate): .................................................................................................................................

Rating

Rating Endorsement

Description

ACP Area Control Procedure

OCN

Oceanic

ACS Area Control Surveillance

TCL

Terminal Control

OCN

Oceanic

4. DETAILS OF APPLICABLE RATING TRAINING COURSE

(Completed by the Applicant)

Rating: .......................................

Approved Course completed (dd/mm/yyyy): ..................................... Course number: .......................

Name of training organisation:........................................................................................................................................................................

5. DECLARATION BY UNIT

(Completed by the Unit Manager)

I, the undersigned, hereby certify that:

The applicant meets the relevant requirements of Commission Regulation (EU) 2015/340.

The applicant is recommended for a Unit Endorsement Assessment.

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

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

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

Forenames: ....................................................................................................

Post held: ...........................................................................

Unit: ...............................................................................................................................

6. FINANCIAL DECLARATION

(MUST BE COMPLETED BY APPLICANT EVEN IF PAYMENT IS MADE BY A THIRD PARTY)

I am applying for the initial issue of an Air Traffic Controller (ATCO) Licence.

I hereby declare that to the best of my knowledge the particulars entered on this application are accurate.

I enclose the charges payable on application in accordance with the Scheme of Charges ( ).

I agree to pay any additional charges which may become payable in respect of this application under the Scheme of Charges.

Name of Applicant (as shown in 1): .............................................................................................................................................................

Signature of Applicant (named in 1): ........................................................................................................................................

Date: ....................................

7. PAYMENT BY A THIRD PARTY

If payment for this application is not being made by the applicant, this form must be countersigned by the payee.

I, (name) ....................................................................................authorise the Civil Aviation Authority to use the details given on the

attached payment authorisation (FCS1500) in support of this application.

Signature of Payer: ..................................................................... Date: .................................

Address: ....................................................................................................................................................................................................

Contact Telephone Number: .......................................................

8. SUBMISSION INSTRUCTIONS

Please check:

•

All Sections relevant to the application have been completed;

The declaration has been signed by the applicant and the Unit Manager; and

•

The correct remittance is included with the application (refer to Section 7 Guidance Notes);

•

when completed, return this form to:

ATCO Licensing Section, Licensing Assessment, Safety and Airspace Regulation Group, Civil Aviation Authority, Aviation House,

Gatwick Airport South, West Sussex RH6 0YR or e-mail to: ats.licensing@caa.co.uk