CIVIL AVIATION AUTHORITY OF BOTSWANA P. O. Box 250, Gaborone, Botswana Tel: +267 3913236/3688200 Fax +267 3913121 FLIGHT SAFETY DIRECTORATE APPLICATION FOR ISSUE, VALIDATION, EXTENSION OR RENEWAL OF AN AIRCRAFT MAINTENANCE ENGINEER S LICENCE This application is in respect of: (Delete as necessary) (a) Initial Issue (b) Issue in Continuation (c) Validation (d) Extension (e) Renewal NOTES: (a) Initial issue is when the applicant does not hold and has never held a Botswana Aircraft Maintenance Engineer s Licence of the type for which this application is now made. (b) Issue in Continuation indicates that the applicant is applying for a Botswana Aircraft Maintenance Engineer s Licence to be issued in continuation of a similar licence issued by another Authority. (c) Validation indicates that the applicant requires that a licence, issued by another Authority, be validated within Botswana but does not seek the issue of Botswana Aircraft Maintenance Engineer s licence. (d) Extension means: inclusion of an additional Category, extension within a Category, inclusion of an additional rating of Category X, inclusion of an additional radio rating. (e) Renewal means renewal of a license or validation issued by the CAAB. (f) The completed form, together with the appropriate fee as shown in the Air Navigation Regulations, is to be forwarded to the Director, Flight Safety, Civil Aviation Authority of Botswana. The fee may be paid in the form of cash or bank transfer. PART A To be completed by all applicants: 1. Full name 2. Nationality 3. of birth (day-month-year) 4. Address (for licence, and to which all Notices should be sent) 5. Applicant s Telephone 6. E-mail address 7. Employer s Name Mailing Address Physical Address 8. Employed as 9. of Commencement 10. Have you ever applied previously to any authority for the issue of an Aircraft Maintenance Engineer s Licence? If so, state authority and results of your application. PART B To be completed when applying for: Initial Issue or Extension 11. Category sought 12. Type(s) of airframe, engine, or rating of Category X or Radio (SINGLE QUOTA ONLY) 1
PART C To be completed when applying for Renewal 13. Approximate date of last certification in accordance with the Air Navigation Regulations 14. Are you conversant with the current - (a) Air Navigation Regulations? (b) Engineering Notices? 15. Have you copies of all current Notices as shown in the latest issue of the index? 16. If not, state missing numbers 17. Declaration: I hereby certify that during the period to I have exercised the privileges of my Aircraft Maintenance Engineer s Licence No. Category NOTE In the event that this application is made in respect of an expired licence, the following declaration by the employer is required: I/We hereby certify that the applicant, of his/her licence since the date of expiry of the said licence. has not exercised the privileges Signed For and on behalf of Position held PART D To be completed when applying for: Issue, Continuation or Validation 18. Name of Issuing Authority 19. No. of licence 20. of Issue 21. Expiry 22. Type(s) of airframes to be included in Category A: 23. Type(s) of airframes to be included in Category B: 24. Type(s) of airframes to be included in Category C: 25. Type(s) of airframes to be included in Category D: 26. Ratings to be included in Category X or Radio: PART E To be completed by all applicants: 27. I hereby declare that the particulars given in this application are true in every respect and enclose the statutory fee prescribed in the Air Navigation Regulations. Signature 2
PART F To be completed when applying for: Extension. Guidance for the completion of this Schedule may be had from the Civil Aviation Authority of Botswana. 28. Have you ever applied previously to any authority for the extension now sought? If yes, state authority and results. Description of work completed completed Signature of Person in Charge hh bdd h fffff fffffnnn Continue on supplementary sheet if necessary *NOTE - The person in charge should only append his signature when he is satisfied that the applicant has participated in or has satisfactorily completed the inspection. An applicant may be considered to have participated when he has taken an active interest in the inspection. 3
PART G To be completed when applying for: Issue or Issue in Continuation In the columns below, state in date order Full Particulars of your employment and experience including, if applicable, Air Force service, apprenticeship, or practical experience gained during studentship at an aeronautical school or college. For initial applicants only the experience quoted in column 4 should be confirmed by signed statements, where possible, from the persons mentioned in column 3. From (1) s (3) To (2) Name and Address of employer and person in charge of department (4) Position held and PRECISE NATURE of work on which engaged stating TYPES of airframes/engines/equipment 4
From (1) s (3) To (2) Name and Address of employer and person in charge of department (4) Position held and PRECISE NATURE of work on which engaged stating TYPES of airframes/engines/equipment Complete on supplementary sheet if necessary PART H Summary and Recommendations FOR USE IN CIVIL AVIATION AUTHORITY OF BOTSWANA ONLY Signature of Recommending Officer Place Fee paid BWP Receipt No. 5