Application For Air Traffic Controllers - Kiwa

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Application for air traffic controllers
PO Box 4, 2280 AA Rijswijk (ZH), NL
E-mail: vergunningen@kiwa.nl
1
Explanation
1.1
1.3
Use this form for the application of the (first) issue of a (student) air
Please send the application to Kiwa Register at the address given above.
traffic controllers licence or revalidation, renewal of rating(s)
1.4
endorsement or the re-issue of a licence document.
After your application has been correctly submitted and paid in full,
processing will take approximately 15 working days to complete.
1.2
A fixed fee will be charged for processing the applications listed under
1.5
1.1. You will receive an invoice for the fee owed. If payment is made
Incomplete or incorrectly completed forms (including not submitting the
by means of crediting a Kiwa Register account, then the holder of the
required documents) will not be processed.
current account must complete and sign section 7 of this form.
1.6
For additional information please visit our website:
2
Particulars of applicant
2.1 Name
2.2 Given name(s)
2.3 Licence number (i.a.)
2.4 Date of birth and place of birth
2.5 Nationality
2.6 Address
2.7 Postal code and place of residence
2.8 Correspondence address
2.9 Postal code and place of residence
2.10
Telephone number(s)
Private
Mobile
2.11 E-mail address
3
Application type
Issue of a Student ATCO licence, rating(s) and rating endorsement(s)
(continue from section 4)
Issue of an ATCO licence, rating(s) and rating endorsement(s)
(continue from section 4)
Issue of a licence endorsement(s)
(continue from section 4)
Language proficiency endorsement
(continue from section 4)
Revalidation of an ATCO licence unit endorsement(s)
(continue from section 4)
Revalidation of a licence endorsement(s)
(continue from section 4)
Renewal of an ATCO licence unit endorsement(s)
(continue from section 4)
Renewal of a licence endorsement(s)
(continue from section 4)
Re-issue of a licence document (following loss or theft)
(continue from section 6)
4
Rating / Rating endorsement / ATC Unit / Sector
Rating
Rating endorsement(s)
Unit
Sector
Working position
ADI
TWR
GMC
GMS
AIR
RAD
ADI
TWR
GMC
GMS
AIR
RAD
APS
TCL
ACS
TCL
APP
Continue on the next page
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