SECTION 1 PRE-FLIGHT OPERATIONS AND DEPARTURE Use of checklist, airmanship, anti-icing/de-icing, procedures, etc. Apply in all sections

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1 Instrument Rting - IR(A) Skill test (PBN) SECTION 1 PRE-FLIGHT OPERATIONS AND DEPARTURE Use of checklist, irmnship, nti-icing/de-icing, procedures, etc. Apply in ll sections Applicnts license numer or nme: FS/A Pss Fil Exminer's signture Use of flight mnul (or equivlent) especilly /c performnce clcultion, mss nd lnce Use of Air Trffic Services document, wether document c Preprtion of ATC flight pln, IFR flight pln/log d Identifiction of the required nvids for deprtures, rrivls nd pproch procedures e Pre-flight inspection f Wether minim g Txiing h PBN deprture (if pplicle): - Check tht the correct procedure hs een loded in the nvigtion system; - Cross-check etween the nvigtion system disply nd the deprture chrt i Pre-tke off riefing. Tke off i Trnsition to instrument flight j Instrument deprture procedures, ltimeter setting k ATC liison - complince, R/T procedures SECTION 2 GENERAL HANDLING ( ) Control of the eroplne y reference solely to instruments, including: level flight t vrious speeds, trim Climing nd descending turns with sustined Rte 1 turn c d(+) e Recoveries from unusul ttitudes, including sustined 45 nk turns nd steep descending turns Recovery from pproch to stll in level flight, climing/descending turns nd in lnding configurtion Limited pnel, stilised clim or descent t Rte 1 turn onto given hedings, recovery from unusul ttitudes SECTION 3 EN-ROUTE IFR PROCEDURES ( ) Trcking, including interception, e.g. NDB, VOR, or trck etween wypoints Use of nvigtion system nd rdio ids c Level flight, control of heding, ltitude nd irspeed, power setting, trim technique d Altimeter settings e Timing nd revision of ETAs (en-route hold if required) f Monitoring of flight progress, flight log, fuel usge, systems mngement g Ice protection procedures, simulted if necessry h ATC liison - complince, R/T procedures EXT-PUB Pge 1/3

2 Instrument Rting - IR(A) Skill test (PBN) SECTION 3 ARRIVAL PROCEDURES Applicnts license numer or nme: FS/A Pss Fil Exminer's signture Setting nd checking of nvigtionl ids, if pplicle Arrivl procedures, ltimeter check c Altitude nd speed constrints, if pplicle d PBN rrivl (if pplicle): - Check tht the correct procedure hs een loded in the nvigtion system - Cross check etween the nvigtion system disply nd the rrivl chrt SECTION 4( ) 3D OPERATIONS (**) Setting nd checking of nvigtionl ids Check Verticl Pth ngle For RNP APCH: - Check tht the correct procedure hs een loded in the nvigtion system - Cross check etween the nvigtion system disply nd the pproch chrt Approch nd lnding riefing, including descent/pproch/lnding checks, including identifiction of fcilities c(*) Holding procedure d Complince with pulished pproch procedure e Approch timing f Altitude, speed heding control, (stilised pproch) g(*) Go-round ction h(*) Missed pproch procedure / lnding i ATC liison - complince, R/T procedures SECTION 5 ( ) 2D OPERATIONS (**) Setting nd checking of nvigtionl ids For RNP APCH: - Check tht the correct procedure hs een loded in the nvigtion system - Cross check etween the nvigtion system disply nd the pproch chrt Approch nd lnding riefing, including descent/pproch/lnding checks, including identifiction of fcilities c(*) Holding procedure d Complince with pulished pproch procedure e Approch timing f Altitude/Distnce to MAPT, speed, heding control (stilised pproch), Stop Down Fixes (SDF(s)), if pplicle g(*) Go-round ction h(*) Missed pproch procedure / lnding i ATC liison - complince, R/T procedures EXT-PUB Pge 2/3

3 Instrument Rting - IR(A) Skill test (PBN) SECTION 6 FLIGHT WITH ONE ENGINE INOPERATIVE (multi-engine eroplnes only) ( ) Applicnts license numer or nme: FS/A Pss Fil Exminer's signture Simulted engine filure fter tke-off or on go-round Approch, go-round nd procedurl missed pproch with one engine inopertive c Approch nd lnding with one engine inopertive d ATC liison - complince, R/T procedures (*) My e performed in n FFS. FTD 2/3 or FNPT II (+) My e performed in either section 4 or section 5 ( ) Must e performed y sole reference to instruments (**) To estlish or mintin PBN privileges one pproch in either Section 4 or Section 5 shll e n RNP APCH. Where n RNP APCH is not prcticle, it shll e performed in n ppropritely equipped FSTD. EXT-PUB Pge 3/3

4 APPLICATION AND REPORT FORM FOR ATPL, MPL, TPYE RATING, CLASS RATING SKILL TEST AND PROFICIENCY CHECK Aeroplnes nd helicopters APPLICATION AND REPORT FORM FOR ATPL, MPL, TPYE RATING, CLASS RATING SKILL TEST AND PROFICIENCY CHECK Aeroplnes nd helicopters Applicnt s lst nme: SE-SP: A H ME-SP:A H Aircrft: Applicnt s first nme: SE-MP: A H ME-MP: A H Signture of pplicnt: Opertions: SP MP Type of license held Checklist: Trining record Type rting: License numer: Skill test: Clss rting: IR: Stte of license issue: Proficiecy check: ATPL: MPL: 1 Theoreticl trining for the issue of type or clss rting performed during period From: To: At: Pss mrk: Signture of HT: Type nd numer of licence: Nme(s) in cpitl letters: 2 FSTD FSTD (ircrft type) Three or more xes: Yes No Redy for service nd used: FSTD mnufcturer Motion or system: Visul id: Yes No FSTD opertor FSTD ID code: Totl trining time t the controls: Loction, dte nd time: Instrument pproches t erodromes to decision ltitude or height of: Type nd numer of licence: Type rting instructor Clss rting instructor.. instructor Signture of instructor: Nme(s) in cpitl letters: 3 Flight trining: in the ircrft in the FSTD (for ZFTT) Type of ircrft: Registrtion: Flight time t the controls: Tkeoffsoffs, pproches nd lndings): Trining erodromes or sites (tke- Lndings Tke-off time: Lnding time: Loction nd dte: Type rting instructor Clss rting instructor Signture of instructor: Nme(s) of instructor in cpitl letters 4 Skill test Proficiency check Skill test nd proficiency check detils: Aerodrome or site Tke-off time: Totl flight time Lnding time: Pss Fil Reson(s) why, if filed: Loction nd dte: Exminer s certificte numer: Signture of exminer: SIM or ircrft registrtion: Type nd numer of licence: Nme(s) in cpitl letters: LIC-FRM-276 Rev.No. 1/ EXT-PUB Pge 1/1

5 Skill test, proficiency check nd ssessment of competence pplicnt's nd exminer's declrtion APPLICANT'S DECLARATION / IZJAVA KANDIDATA I declre tht the informtion provided on this form is correct nd I hve een informed of the result of the skill test, proficiency check or ssessment of competence. Izjvljujem kko su podci n ovom orscu točni, te kko sm upoznt s rezulttom ispit prktične osposoljenosti, provjere stručnosti ili procjene stručnosti. Nme Signture Dte Dtum EXAMINER SHALL BEFORE TEST / ISPITIVAČ ĆE PRIJE TESTA: (1) ensure tht communiction with the pplicnt cn e estlished without lnguge rriers; (2) verify tht the pplicnt complies with ll the qulifiction, trining nd experience requirements in Prt-FCL for the issue, revlidtion or renewl of the licence, rting or certificte for which the skill test, proficiency check or ssessment of competence is tken; (3) mke the pplicnt wre of the consequences of providing incomplete, inccurte or flse informtion relted to their trining nd flight experience. (1) osigurti d komunikcij s podnositeljem zhtjev može iti uspostvljen ez jezičnih preprek (2) potvrditi d podnositelj zhtjev ispunjv sve kvlifikcije, zhtjeve osposoljvnj i iskustv Dijel-FCL z stjecnje, produžvnje ili onvljnje dozvole, ovlštenj ili certifikt z koji se ispit prktične osposoljenosti, provjer stručnosti ili procjen stručnosti provodi (3) upoznti podnositelj zhtjev s posljedicm dostvljnj nepotpunih, netočnih ili neistinitih informcij vezno uz njihovo osposoljvnje i letčko iskustvo EXAMINER'S DECLARATION: I DECLARE THAT I received informtion from the pplicnt regrding his/her experience nd instruction, nd found tht experience nd instruction complying with the pplicle requirements in Prt-FCL. IZJAVLJUJEM kko sm primio sve informcije od kndidt vezno z njegovo iskustvo i osposoljvnje, i potvrdio d su iskustvo i osposoljvnje u skldu s primjenjivim zhtjevim Dijel-FCL. EXAMINER'S CONFIRMATION: I confirm tht ll the required mnoeuvres nd exercises hve een completed, nd tht the pplicnt's theoreticl knowledge hs een confirmed y verl exmintion (where pplicle). Potvrđujem kko su svi zhtijevni mnevri i vježe provedeni, te je potvrđeno kndidtovo teorijsko znnje usmenim ispitivnjem (kd je primjenjivo) Nme Signture Dte Dtum ADITIONAL DECLARATION FOR non-ccaa EXAMINERS / DODATNA IZJAVAVA ZA non-ccaa ISPITIVAČE I herey declre tht I hve reviewed nd pplied the relevnt ntionl procedures nd requirements of the pplicnt s competent uthority contined in version (insert document version, i.e ) of the Exminer Differences Document, s pulished y EASA. Ovim putem izjvljujem kko sm se upozno i primijenio relevntne ncionlne zhtjeve i procedure tijel ndležnog z izdvnje dozvole podnositelj zhtjev koje se nlze u verziji (upiši roj verzije dokument, npr ) Exminers Difference Dokument, izdnog od strne EASA-e Nme Signture Dte Dtum Exminers remrks from skill test/ proficiency check / ssessment of competence: Primjede i npomene ispitivč s ispit prktične osposoljenosti / provjere stručnosti / procjene stručnosti LIC-FRM-313 Rev.No. 2 / INT-PUB Pge 1/1