Form. No. RPPL-F-103E AMDT No. 1.0 Page No. 1 of 9 Issue Date: 13/10/2014

Transcription

1 Pge No. 1 of 9 Prt 1 - APPLICATION NOTE 1: It is n offene for person to mke, proure to e me, or ssist in mking ny flse representtions for the purpose of prouring for ny reson the issue, vlition, extension or re-issue of liene or the issue, renewl or revlition of rting, uthoristion or ertifite, whether for tht person or ny other person. NOTE 2: Commission Regultion (EU) No. 1178/2011 (s mene), requires tht n iniviul hs ll of their lienes ministere y the Ntionl Avition Authority tht hols their meil reors (Prt MED.A.030 n FCL.015). If your meil reors re not hel y the IAA, your pplition will e rejete. Plese omplete the form in BLOCK CAPITALS hving re the guine notes tthe to this form. 1. APPLICANT S PERSONAL DETAILS To e omplete y the pplint Surnme... First Nme(s)... Title (Mr / Mrs / Ms et)... Dte of Birth (/mm/yyyy)... Ntionlity... Ple of Birth (Town)... (Country)... Permnent ress Postoe... Contt Tel. No.... Moile Tel. No.... E-mil ress... Fx Numer... Aress for orresponene (if ifferent from ove) Postoe DETAILS OF EXISTING FLIGHT CREW LICENCE(S) HELD To e omplete y the pplint Stte of Issue Type of Liene Ctegory of Liene Liene No. Expiry Dte (e.g. PPL, CPL et) (e.g. Aeroplne, Heliopter et) 3. APPLICATION (tik s pproprite) To e omplete y the pplint I m pplying for the issue of Prt-FCL PPL(H), inluing the Type rting inite elow; Plese speify Type:.... If pplying for the issue of Prt-FCL PPL(H) on onversion of n ICAO Annex 1 omplint PPL(H), CPL(H) or ATPL(H), plese tik this ox 4. MEDICAL CERTIFICATE To e omplete y the pplint Stte of Issue Clss Dte of Meil exmintion Expiry Dte of Clss 2 privileges AME Nme, Meil Centre & Lotion AME No. Detils of ny Limittions / Enorsements IAA use only

2 Pge No. 2 of 9 5. TRAINING COURSE, FLYING EXPERIENCE & CREDITING To e omplete y the ATO (Note: Tik the ertifition t either 5.1 (Full ourse) or 5.2 (ICAO liene onversions), s pplile. I ertify tht (nme).. hs: or 5.1 stisftorily omplete ourse of theoretil knowlege n flight instrution (s set out in Setions 1 to 9 of the Trining Course Summry elow) for the issue of Prt-FCL Privte Pilot Liene (Heliopter). I hve exmine the pplints trining reors n pilot logook(s), n the pplint meets the requirements for the issue of Prt-FCL Privte Pilot Liene (Heliopter). I herey reommen the pplint for the PPL(H) skill test. 5.2 presente n ICAO pilot s liene n pilot logook(s) n tht the flight experiene shown therein (s set out in Setion 10 of the Trining Course Summry elow) meets the requirements for the issue of Prt-FCL Privte Pilot Liene (Heliopter). I reommen the pplint for the PPL(H) skill test Trining Course Summry (For ICAO liene onversions, omplete setion 10 only of this tle) Prt-FCL minim (Hours) 1. Theoretil knowlege instrution Supervise Solo flight time in Heliopters Supervise Solo ross-ountry flight time in Heliopters 5 4. Dte of most reent solo ross-ountry flight of t lest 185 km (100 NM) uring whih full stop lnings t two eroromes ifferent from the erorome of eprture hve een me (Speify Aeroromes of Deprture n Lnings elow) Hours omplete Dte.. /../.. IAA use only Route: From to _ From to _ Trk Miles NM Trk Miles NM From to _ Trk Miles NM TOTALNM 5. Dul instrution in Heliopters Flight instrution in FNPT or FFS (Type of Devie _) (FSTD Ientifition No. _) 5 (mx) 7. Creit for PIC flight time in irrft tegories other thn Heliopters (i..w. FCL.210.H ()) 6 (mx) Stte Airrft Ctegory PIC flight time flown in _ (e.g. Aeroplne, Gyroplne, 3-xis Mirolight et.) Totl PIC flight time in Airrft Ctegory ove _ 8 Totl Flight Time 45 9 Totl flight time on TYPE of heliopter to e use for the skill test Totl flight time s pilot of Heliopters (ICAO liene onversions only) 100 Approve Trining Orgnistion (ATO). ATO No..... Competent Authority of ATO. Nme of He of Trining.. Signture of He of Trining: Dte:..

3 Pge No. 3 of 9 6. DECLARATION OF FURTHER TRAINING (if pplile) To e omplete y the ATO I ertify tht (nme). hs omplete further trining s speifie y the Exminer following previous prtil pss or filure of the skill test.. I reommen the pplint for PPL(H) skill test. Approve Trining Orgnistion (ATO). ATO No..... Competent Authority of ATO. Nme of He of Trining.. Signture of He of Trining: Dte:.. 7. THEORETICAL KNOWLEDGE EXAMINATIONS To e omplete y the pplint Level of exmintions psse Memer Stte uner whose uthority exms were psse Dte of finl exmintion pss Expiry te of exmintion pss IAA use only (e.g. PPL(H), CPL(H) or ATPL(H)) 8. ENGLISH LANGUAGE PROFICIENCY (ELP) To e omplete y the pplint Dte of ELP Assessment Level hieve Nme of Exminer Exminer Numer IAA use only 9. PPL(H) SKILL TEST To e omplete y the pplint Dte of Skill Test pss Nme of Exminer Exminer Numer Competent Authority of Exminer IAA use only 10. APPLICANT S DECLARATION To e omplete y the pplint I herey elre tht:- 1) I o not hol Prt-FCL liene issue y nother EASA Memer Stte; 2) I hve not pplie for Prt-FCL flight rew liene in nother Memer Stte; 3) I hve never hel flight rew liene, issue nother Memer Stte, whih ws revoke or suspene. I further elre tht the informtion given in this form is true n orret to the est of my knowlege n elief. Applint s Signture... Dte...

4 Pge No. 4 of 9 PART 2 EXAMINER REPORT FOR PPL(H) SKILL TEST Nme of pplint:.. Dte of Birth: (/mm/yyyy)... Attempt No.:. Dte of Test: Ple of Test:. Applint s signture: I ertify tht I hve exmine the trining reors (s pplile) n pilot logook(s) of (nme). n tht the entries ontine therein meet, in full, the qulifition, trining n experiene requirements for the initil issue of Prt- FCL Privte Pilot Liene (Heliopter). I hve me the pplint wre of the onsequenes of proviing inomplete, inurte or flse informtion relte to their trining n flight experiene. Exminer s Nme:... Exminer Numer:... Issuing Competent Authority:.... Dte of Skill Test Notifition to the IAA:... /.../.. (of Exminer Certifite) Exminers signture:... Note: Exminers re remine tht they must omplete Prt 2 (Exminer report for PPL(H) skill test) n sumit the originl to the IAA s Personnel Liensing Offie within 7 ys of the te of skill test together with opy of the Notifition of Test onfirmtion emil (inluing signe elrtion). DETAILS OF FLIGHT(S) Attempt No. Dte Airrft Type Registrtion Deprture Blok Times Arrivl Durtion Result: Prtil Prtil pss / only: If pplile, speify ny further trining requirement (hours) prior to re-test: A/C.. Sim/FNPT II... Groun Prtil Re-test Dte Airrft Type Registrtion Deprture Blok Times Arrivl Durtion Result: only If pplile, speify ny further trining requirement (hours) prior to the next ttempt:: A/C.. Sim/FNPT II... Groun

5 Pge No. 5 of 9 Nme of pplint Dte of Birth (/mm/yyyy)... Use of heklist, irmnship, ontrol of heliopter y externl visul referene, nti-iing proeures, et. pply in ll setions Setion 1 Pre-flight or post-flight heks n proeures e f Heliopter knowlege, (for exmple tehnil log, fuel, mss n lne, performne), flight plnning, NOTAM n wether riefing Pre-flight inspetion or tion, lotion of prts n purpose Cokpit inspetion n strting proeure Communition n nvigtion equipment heks, seleting n setting frequenies Pre-tke-off proeure, R/T proeure n ATC ompline Prking, shutown n post-flight proeure 1 st Attempt 2 n Attempt Comments Result of Setion (irle s pplile) Setion 2 Hover mnoeuvres, vne hnling n onfine res e f g h i j k l m n o p q Tke-off n lning (lift-off n touh own) Txi n hover txi Sttionry hover with he, ross or til win Sttionry hover turns, 360 left n right (spot turns) Forwr, siewys n kwrs hover mnoeuvring Simulte engine filure from the hover Quik stops into n ownwin Sloping groun or unprepre sites lnings n tke-offs Tke-offs (vrious profiles) Crosswin n ownwin tke-off (if prtile) Tke-off t mximum tke-off mss (tul or simulte) Approhes (vrious profiles) Limite power tke-off n lning Autorottions, (FE to selet two items from: si, rnge, low spee n 360 turns) Autorottive lning Prtie fore lning with power reovery Power heks, reonnissne tehnique, pproh n eprture tehnique 1 st Attempt 2 n Attempt Comments Result of Setion (irle s pplile)

6 Pge No. 6 of 9 Nme of pplint.. Dte of Birth (/mm/yyyy)... Use of heklist, irmnship, ontrol of heliopter y externl visul referene, nti-iing proeures, et. pply in ll setions Setion 3 Nvigtion - en-route proeures e f Nvigtion n orienttion t vrious ltitues or heights n mp reing Altitue or height, spee, heing ontrol, oservtion of irspe n ltimeter setting Monitoring of flight progress, flight log, fuel usge, enurne, ETA, ssessment of trk error n re-estlishment of orret trk n instrument monitoring Oservtion of wether onitions n iversion plnning Use of nvigtion is (where ville) ATC liison with ue oservne of regultions, et. 1 st Attempt 2 n Attempt Comments Result of Setion (irle s pplile) Setion 4 Flight proeures n mnoeuvres Level flight, ontrol of heing, ltitue or height n spee Climing n esening turns to speifie heings Level turns with up to 30 nk, 180 to 360 left n right Level turns 180 left n right y sole referene to instruments 1 st Attempt 2 n Attempt Comments Result of Setion (irle s pplile)

7 Pge No. 7 of 9 Nme of pplint... Dte of Birth (/mm/yyyy)... Use of heklist, irmnship, ontrol of heliopter y externl visul referene, nti-iing proeures, et. pply in ll setions Setion 5 Anorml n emergeny proeures (simulte where pproprite) NOTE: Where the test is onute on n ME heliopter, simulte engine filure rill, inluing n SE pproh n lning shoul e inlue in the test. 1 st Attempt 2 n Attempt Comments The FE shoul selet four items from the following: e f g Engine mlfuntions, inluing governor filure, rurettor or engine iing n oil system, s pproprite Fuel system mlfuntion Eletril system mlfuntion Hyruli system mlfuntion, inluing pproh n lning without hyrulis, s pplile Min rotor or nti-torque system mlfuntion (FFS or isussion only) Fire rills, inluing smoke ontrol n removl, s pplile Other norml n emergeny proeures s outline in n pproprite flight mnul n with referene to Appenix 9 C to Prt-FCL, setions 3 n 4, inluing for ME heliopters: () Simulte engine filure t tke-off: (1) rejete tke-off t or efore TDP or sfe fore lning t or efore DPATO; (2) shortly fter TDP or DPATO. () Lning with simulte engine filure: (1) lning or go-roun following engine filure efore LDP or DPBL; (2) following engine filure fter LDP or sfe fore lning fter DPBL. Result of Setion (irle s pplile)

8 Pge No. 8 of 9 PART 1 GUIDANCE NOTES, PAYMENT FORM & SUBMISSION INSTRUCTIONS Guine Notes for Prt 1 All setions of Prt 1 of the pplition form must e omplete y the pplint personlly, exept where inite. In orer for the IAA to proess the pplition s quikly s possile, it is importnt tht the pplition form is omplete orretly. Plese omplete the pplition form in onjuntion with the following guine notes. Setion 1 Applint s Personl Detils Plese ensure tht your First Nme(s) re entere extly s per the eviene of ientity oument tht you sumit with your pplition - see Sumission instrutions t the en of this form. The permnent ress will e entere on your Prt-FCL PPL(H), n will lso e the ress to whih the liene will e sent. If you wnt the liene sent to n lterntive ress, plese enter the etils uner orresponene ress. Setion 2 Detils of Existing Flight Crew Liene(s) hel Plese enter etils of ll flight rew liene(s) (inluing foreign lienes) hel. Setion 3 - Applition Plese inite the Type rting for whih you re pplying, n if pplile, inite if this is n pplition for onversion of n ICAO Annex 1 omplint PPL(H), CPL(H) or ATPL(H). Setion 4 Meil Certifite Plese enter etils of your vli Prt-MED Clss 1 or 2 Meil Certifite. Note: JAR-FCL meil ertifite is eeme to e meil ertifite issue in orne with Prt-MED. Setion 5 Trining Course, Flying experiene & Creiting This setion must e omplete y the ATO s He of Trining or nominte Deputy. The requirements for the initil issue of Prt-FCL PPL(H) re set out in Suprt C, Setions 1 & 3 of Commission Regultion (EU) No. 1178/2011 (s mene), n in Annex III, Prt B for onversion of n ICAO Annex 1 omplint liene. Creit for PIC flight time in n irrft tegory other thn Heliopters n only e lime if pilot liene, or equivlent privileges, is hel for the pproprite tegory of irrft. Any suh reit shll e lulte in orne with FCL.210.H (). Setion 6 Delrtion of Further Trining This setion must e omplete y the ATO s He of Trining (or nominte Deputy) where previous ttempt t the PPL(H) skill test resulte in prtil pss or fil n the exminer speifie the nee for further trining efore re-test / further ttempt. Setion 7 Theoretil Knowlege Exmintions Plese enter etils of your theoretil knowlege exmintion pss. If the exmintions hve not een psse with the IAA, the results will e verifie s prt of the liene issue proess with the Stte uner whose uthority the exms were psse. Setion 8 English Lnguge Profiieny (ELP) Plese enter etils of your ELP ssessment. Setion 9 PPL(H) Skill Test Plese enter etils of your skill test pss. Note: Your pplition will not e proesse until the IAA hs reeive the omplete originl Prt 2 of this form from the Exminer(s) in respet of ll ttempts t the PPL(H) skill test. Setion 10 Applint s Delrtion This setion must e omplete fter reviewing ll informtion entere on the pplition form. If you re unle to gree with ny of the sttements in the elrtion, plese ontt the Personnel Liensing Offie for further vie efore sumitting this pplition..

9 Pge No. 9 of 9 (Heliopter) SUBMISSION INSTRUCTIONS (see Guine Notes) Sen your omplete pplition form to: Personnel Liensing Offie, Irish Avition Authority, D Olier Street, Dulin 2, Ireln. Plese enlose the following:- All pilot logooks Copy of your vli Prt-MED or JAR-FCL Clss 1 or 2 Meil Certifite Copy of your port or Ntionl Ientity r s eviene of ientity Copy of your theoretil knowlege exmintion results Complete pyment form (if pying y reit / eit r), or heque / postl orer. If Applile Copy of ICAO PPL(H) / CPL(H) / ATPL(H) n vliting meil ertifite (ICAO liene onversions ONLY) Copy of relevnt flight rew liene(s) / qulifition(s) n vliting meil ertifite(s) (if liming reit in Setion 5 for flight experiene in n irrft tegory other thn heliopters). English Lnguge Profiieny Assessment form RPPL-F-270 (or lol equivlent if omplete with non-iaa ELP ssessor) (Note: the eptne of non-iaa ELP ssessor or English Lnguge Assessment Boy must e onfirme y the IAA in vne) Copy of ATO Approvl Certifite (if PPL(H) ourse is omplete with non-iaa pprove ATO). Copy of the Flight Exminer s flight rew liene n exminer ertifite (if skill test ws omplete with non-iaa ertifite Exminer) Copy of the FSTD Qulifition Certifite (if n FSTD is use on the trining ourse) Plese note tht filure to sumit ll require oumenttion my result in the return of your pplition. PAYMENT FORM The urrent PPL(H) issue fee n e foun uner Fees for Flight Crew Liensing on the IAA wesite ( The issue fee inlues the issue of one heliopter type rting. Enorsement of itionl rting(s) (e.g. Night rting or itionl Type rting(s)) will inur n itionl fee per rting. Full etils of fees hrge n levie y the IAA re pulishe in the Irish Avition Authority (Fees) (No. 2) Orer. I m pying y:- CREDIT / DEBIT CARD CHEQUE POSTAL ORDER Plese mke heques pyle to Irish Avition Authority. - PLEASE DO NOT SEND CASH - Plese note tht we o not ept AMERICAN EXPRESS or DINERS CARD. If pying y reit or eit r plese omplete the informtion require elow (in lok pitls). Note: All r etils re estroye upon ompletion of the trnstion. Nme of Cr holer (s stte on the r) Cr Numer Vli from: / Expiry Dte / Seurity Coe (lst 3 igits on signture strip on reverse of r)