SKILL TEST PPL(A) AEROPLANE SE ME Application and report form A. Udfyldes af ansøgeren/to be filled out by the applicant:
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1 SKILL TEST PPL(A) AEROPLANE SE ME Applition n rport orm A. Uyls nsørn/to ill out y t pplint: CPR-nr./Dt o Birt: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj:/strt: Postnr. o y/postl o n ity: -mil: Tl./Tlpon: Dto or unrskrit/dt o sintur: Unrskrit/Sintur: B: Uyls skoln/to ill out y ATO: Nm o ATO: (Us stmp): Spiition o lit tim Totl: Dul Solo FNPT or sim Critin o lit tim (tt oumnttion) I ry rtiy tt t pplint s pss t rquir trinin n tt t pplint ulils t rquirmnt or t issu o Privt Pilot Lin (Aropln) Dt o sintur o H o Trinin Sintur o H o Trinin C: To ill out y t Exminr: Dt o tst: Lin Enorsmnt: Typ o irrt: Nm o Exminr or stmp: Stmp o Exminr, Autoristion no. o Exminr or stmp: I ry vriy tt t pplint s pss t rquir trinin n tt t pplint ulills t rquirmnt or t issu o Privt Pilot Lin (Aropln) Dt o sintur o Exminr Sintur o Exminr Stion 1: Pss Finl rsult: Fil Stion 2: Pss Fil Stion 3: Rsult o t tst Stion 4: Stion 5: Pss Fil Pss Fil Pss Fil Tmporry lin issu (opy nlos): Stion 6: Not Applil Pss Fil Pss Prtil Pss Fil Ys No Vli until: PPL(A) Dmr 2014 P 1 o 5 Trikstyrlsn, Evr Tomsns Vj 14, 2300 K. S., Tl.: , -mil: ino@trikstyrlsn.k
2 For til instrutions s AMC1 FCL.235 Us o klist, irmnsip, ontrol o ropln y xtrnl visul rrn, nti/-iin prours, t. pply in ll stions. Nm o Applint: SECTION 1 PRE-FLIGHT OPERATIONS AND DEPARTURE Pss Fil Pr-lit oumnttion, NOTAM n wtr ri Mss n ln n prormn lultion Aropln insption n srviin Enin strtin n tr strtin prours Txiin n rorom prours, pr tk-o prours Tk-o n tr tk-o ks Arorom prtur prours ATC liison omplin R/T prours SECTION 2 GENERAL AIRWORK Pss Fil ATC liison omplin R/T prours Strit n lvl lit, wit sp ns Climin i. Bst rt o lim i Climin turns Lvllin o Mium (30 nk) turns Stp (45 nk) turns (inluin ronition n rovry rom spirl iv) Flit t ritilly low irsp wit n witout lps Stllin i. Cln stll n rovr wit powr i Appro to stll snin turn wit nk nl 20, ppro oniurtion Appro to stll in lnin oniurtion Dsnin i. Wit n witout powr i Dsnin turns (stp liin turns) Lvllin o SECTION 3 EN-ROUTE PROCEDURES Pss Fil Flit pln, rkonin n mp rin Mintnn o ltitu, in n sp Orinttion, timin n rvision o ETAs, lo kpin Divrsion to ltrnt rorom (plnnin n implmnttion) Us o rio nvition is Bsi instrumnt lyin k (180 turn in simult IMC) Flit mnmnt (ks, ul systms n rurttor i, t.) ATC liison omplin R/T prours PPL(A) Dmr 2014 P 2 o 5
3 For til instrutions s AMC1 FCL.235 Us o klist, irmnsip, ontrol o ropln y xtrnl visul rrn, nti/-iin prours, t. pply in ll stions. Nm o Applint: SECTION 4 APPROACH AND LANDING PROCEDURES Pss Fil Arorom rrivl prours Prision lnin (sort il lnin); ross win, i suitl onitions vill Flplss lnin Appro to lnin wit il powr (SINGLE ENGINE ONLY) Tou n o Go-roun rom low it ATC liison omplin R/T prours Ations tr lit SECTION 5 ABNORMAL AND EMERGENCY PROCEDURES (Tis stion my omin wit stions 1 trou 4) Simult nin ilur tr tk-o (SINGLE ENGINE ONLY) Simult or lnin (SINGLE ENGINE ONLY) Simult prutionry lnin (SINGLE ENGINE ONLY) Simult mrnis Orl qustions Pss Fil SECTION 6 SIMULATED ASYMMETRIC FLIGHT AN RELEVANT CLASS/TYPE ITEMS (Tis stion my omin wit stions 1 trou 5) Simult nin ilur urin tk-o (t s ltitu unlss rri out in lit simultor) Asymmtri ppro n o-roun Asymmtri ppro n ull stop lnin Enin sutown n rstrt ATC liison omplin R/T prours, Airmnsip As trmin y t Flit Exminr ny rlvnt itms o t lss/typ rtin skill tst to inlu, i pplil: i. Aropln systms inluin nlin o utopilot Pss Fil i Oprtion o prssuristion systm Us o -iin n iin systm Orl qustions Som o ts itms my omin t t isrtion o t Flit Exminr PPL(A) Dmr 2014 P 3 o 5
4 For til instrutions s AMC1 FCL.235 Us o klist, irmnsip, ontrol o ropln y xtrnl visul rrn, nti/-iin prours, t. pply in ll stions. Nm o Applint: Dtils o t lit Dstintion rorom On lok On roun Dprtur rorom O lok Airorn Airrt ristrtion Totl lok tim Totl irorn tim No. o lnins: Rmrks/Ovrll ssssmnt/rsons or ilur (i pplil): Nm o instrutor prsnt t t Skill Tst: Sintur o Exminr: Sintur o pplint: PPL(A) Dmr 2014 P 4 o 5
5 For til instrutions s AMC1 FCL.235 Us o klist, irmnsip, ontrol o ropln y xtrnl visul rrn, nti/-iin prours, t. pply in ll stions. Nm o Applint: In orn wit ARA.GEN.315(), () () Unrtn krætr rm, t j v nsøninstispunktt Not: 1. ikk vr ikk i sils t prsonlit rtiikt, rtin, tillls llr ttsttion m smm nvnlssområ o i smm ktori ustt i n nn mlmsstt; 2. ikk r nsøt om t prsonlit rtiikt, rtin, tillls llr ttsttion m smm nvnlssområ o i smm ktori i n nn mlmsstt; o 3. lri r t t prsonlit rtiikt, rtin, tillls llr ttst m smm nvnlssområ o i smm ktori ustt i n nn mlmsstt, som r tilklt llr suspnrt i nn mlmsstt. Ukorrkt oplysninr vrørn ovnstån, kn vær iskvliirn or ustls rtiikt, rtin, tillls m.v. Unrsin ry onirm tt I t t tim o pplition 1. ws not olin ny prsonnl lin, rtiit, rtin, utoristion or ttsttion wit t sm sop n in t sm tory issu in notr Mmr Stt; 2. s not ppli or ny prsonnl lin, rtiit, rtin, utoristion or ttsttion wit t sm sop n in t sm tory in notr Mmr Stt; n 3. s nvr l ny prsonnl lin, rtiit, rtin, utoristion or ttsttion wit t sm sop n in t sm tory issu in notr Mmr Stt wi ws rvok or suspn in ny otr Mmr Stt. 4. Not: Inorrt inormtion rrin t ov n isquliyin or otinin rtiit, rtin, utoriztion, t. Dto:/Dt: Unrskrit:/Sintur: PPL(A) Dmr 2014 P 5 o 5
Result of the test Section 4:
SKILL TEST IR(H) HELICOPTER SE ME Applition n rport orm A. Uyls nsørn/to ill out y th pplint: Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj:/strt:
EIR(A) AEROPLANE SKILLTEST PROFICIENCY CHECK SE ME Application and report form A. Udfyldes af ansøgeren/to be filled out by the applicant:
EIR(A) AEROPLANE SKILLTEST PROFICIENCY CHECK SE ME Applition n rport form A. Ufyls f nsøgrn/to fill out y th pplint: CPR-nr./Dt of Birth: Crtifikt nr./lin no.: (If ny) Ustn Stt/Stt of Lin Issu: Fornvn/First
Result of the test Section 3:
SKILL TEST LAPL(H) HELICOPTER Applition n rport orm A. Uyls nsøgrn/to ill out y th pplint: Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj/strt:
REPORT FORM PPL(A) SK ILL TES. Rating: Block-off: Block-on: Flight time: Landings: Type Rating: Class:
Applint Lst nm(s)*: First nm(s)*: Dt o birth: REPORT FORM PPL(A) SK ILL TES T o lin hl: Lin numbr: Stt o lin issu: 1 First ttmpt: Dtil o th liht : Dt o liht: o ropln: Clss: Ristrtion: Rtin: Dprtur: Dstintion:
Result of the test Section 4:
SKILL TEST IR(A) AEROPLANE SE ME Applition n rport orm A. Uyls nsøgrn/to ill out y th pplint: Dt o Birth: Crtiikt nr./lin no.: (I ny) Ustn Stt/Stt o Lin Issu: Fornvn/First nm(s): Etrnvn/Lst nm: G llr vj:/strt:
REPORT FORM LAPL-A SK ILL TES TMG SEP. Block-off: Block-on: Flight time: Landings: Class rating: SEP TMG
REPORT FORM LAPL-A SK ILL TES T Applint Lst nm(s)*: First nm(s)*: Dt o irth: Typ o lin hl: Lin numr: Stt o lin issu: 1 First ttmpt: Dtil o th light : Typ Dt o light: o ropln: Clss rting: Rgistrtion: Dprtur:
The ATO confirms that the candidate has been trained according to the approved syllabus and assures the level of proficiency required.
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place of birth: place of origin: nationality: initial skill test repetition of failed / partially passed skill test, from date:
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