Application For Air Traffic Controllers - Kiwa Page 3
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Certificates / Documents
6.6
Renewal of an OJTI/STDI/Assessor
Copy of medical certificate
licence endorsement
Copy of refresher training certificate/document proving the successful completion of the training
Copy of the competence assessment form
6.7
Re-issue SCL/ATCO licence
Copy of medical certificate
6.8
Exchange of licence
Copy of a medical certificate
Copy of passport or identity card
Copy of the ATCO licence issued by the other EU member state
7
Payment and correspondence
Fixed fees are charged for processing applications and issuing (Student) ATCO licences. The respective
amounts are listed at
7.1 Payment method
Pay by invoice
Paid at the Kiwa Register desk (enclose the receipt with this application)
Current account of the training organisation (fill in sections 8.4 and 8.5 on this form)
7.2 Correspondence
Correspondence related to this application can be sent to the postal address of the training organisation (fill
in sections 8.4 and 8.5 on this form)
8
Declaration and signature
8.1 Declaration
I hereby:
1. apply for the issue/revalidation/renewal of (Student) ATCO licence, ratings and/or endorsements as
indicated;
2. confirm that the information contained herein is correct at the time of the application;
3. confirm that I am not holding any (Student) ATCO licence issued in another member state (n.a. for exchange
of licence);
4. confirm that I have not applied for any (Student) ATCO licence in another member state;
5. confirm that I have never held a (Student) ATCO licence issued in another member state which has been
revoked or suspended in any other member state.
I am aware that any incorrect information in or accompanying the application form can result in rejection of
the application.
8.2 Location and date
8.3 Applicant’s signature
8.4 Signature of contact at the
training organisation
8.5 Stamp of the training organisation
3/3
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