^Sll&KASI PENYELENGGARA PELAYANAN LALU^LINTAS

KEMENTERIAN PERHUBUNGAN nirektorat JENDERAL PF.RHUBUNGAN UDARA PERATURAN DIREKTUR JENDERAL PERHUBUNGAN UDARA Nomor : KP 248 TAHUN 2014 TENTANG PFTUNJUK TEKNIS BAGIAN 172-01 (STAFF INSTRUCTION PART 172-01) ^Sll&KASI PENYELENGGARA PELAYANAN LALU^LINTAS PENERBANGAN (CERTIFICATION OF AIR TRAFFIC SERVICE PROVIDER) DENGAN RAHMAT TUHAN YANG MAHA ESA DIREKTUR JENDERAL PERHUBUNGAN UDARA, Menimbang Mengingat a bahwa dalam sub bagian 172.022 Peraturan Menteri Perhubungan Nomor KM 49 Tahun 2011 tentang Peraturan Keselamatan Penerbangan Sipil Bagian 172 (Civil Aviation Safety Regulation Part 172) tentang Penyelenggara Pelayanan Lalu Lintas Penerbangan (Air Traffic Service Provider) mengatur ketentuan lebih lanjut mengenai penyelenggara pelayanan lalu lintas penerbangan diatur dengan Peraturan Direktur Jenderal ; b bahwa berdasarkan pertimbangan sebagaimana dimaksud pada huruf a, dipandang perlu menetapkan Petunjuk Teknis Bagian 172-01 (Staff Instruction Part 172-01) Mengenai Sertifikasi Penyelenggara Pelayanan Lalu Lintas Penerbangan (Certification Of Air Traffic Service Provider), dengan Peraturan Direktur Jenderal Perhubungan Udara; 1 Undang-undang Nomor 1 Tahun 2009 tentang Penerbangan (Lembaran Negara Tahun 2009 Nomor 1; Tambahan Lembaran Negara Republik Indonesia Nomor 2. 3. 4956); Peraturan Presiden Nomor 47 Tahun 2009 tetang Pembentukan Organisasi Kementerian Negara Sebagaimana diubah terakhir dengan Peraturan Presiden Nomor 13 Tahun 2014; Peraturan Presiden Nomor 24 Tahun 2010 tentang Kedudukan, Tugas, dan Fungsi Kementerian Negara serta Susunan Organisasi, Tugas, dan Fungsi Eselon I Kementerian Negara sebagaimana telah diubah dengan Peraturan Presiden Nomor 14 Tahun 2014; Laptop sulis/sulis/si CASR 172-01/april 2014

Menetaokan 4 Peraturan Menteri Perhubungan Nomor KM 21 Tahun 2009 tentang Peraturan Keselamatan Penerbangan Sipi Bagian 173 (Civil Aviation Safety Regulation Part 173) tentang Perancangan Prosedur Penerbangan Instrument (Instrument Flight Procedure Design); 5 Peraturan Menteri Perhubungan Nomor KM 22 Tahun 2009 tentang Peraturan Keselamatan Penerbangan Sipi Baeian 175 (Civil Aviation Safety Regulation Part 175) tentang Pelayanan Informasi Aeronautika (Aeronautical Information Services); 6 Peraturan Menteri Perhubungan Nomor KM 24 Tahun 2009 tentang Peraturan Keselamatan Penerbangan bipil Bagian 139 (Civil Aviation Safety Regulation Part 139) tentang Bandar Udara (Aerodrome); 7 Peraturan Menteri Perhubungan Nomor PM 60 Tahun 2010 tentang Organisasi dan Tata Kerja Kementerian Perhubungan sebagaimana diubah terakhir dengan Peraturan Menteri Perhubungan Nomor 68 Tahun 2010; 8 Peraturan Menteri Perhubungan Nomor KM 49 Tahun 2011 tentang Peraturan Keselamatan Penerbangan Sipil Bagian 172 (Civil Aviation Safety Regulation Part 172) tentang Penyelenggara Pelayanan Lalu Lintas Penerbangan (Air Traffic Service Provider); 9 Peraturan Menteri Perhubungan Nomor KM 57 Tahun 2011 tentang Peraturan Keselamatan Penerbangan Sipil Bagian 171 (Civil Aviation Safety Regulation Part 171) tentang Penyelenggara Pelayanan Telekomumkasi Penerbangan (Aeronautical Telecommunication Service Provider) sebagaimana diubah terakhir dalam Peraturan Menteri Perhubungan Nomor PM 29 Tahun 2013; 10 Peraturan Menteri Perhubungan Nomor PM 01 Tahun 2014 tentang Peraturan Keselamatan Penerbangan Sipil Bagian 69 (Civil Aviation Safety Regulations Part 69) tentang Lisensi, Rating, Pelatihan dan Kecakapan Personel Navigasi Penerbangan; MEMUTUSKAN : PERATURAN DIREKTUR JENDERAL PERHUBUNGAN UDARA Menetapkan. ^ PETUNJUK TEKNIS BAGIAN 172-01 (STAFF INSTRUCTION PART 172-01) MENGENAI SERTIFIKASI PENYELENGGARA PELAYANAN LALU LINTASPENERBANGAN (CERTIFICATION OF AIR TRAFFIC SERVICE PROVIDER). Laptop sulis/sulis/si CASR 172-01/april 2014

laptop sulis/sulis/si CASR 172-01/april 2014 Pasal 1 Memberlakukan Petunjuk Teknis Bagian 172-01 (Staff Instruction Part 172-01) Mengenai Sertifikasi Penyelenggara Pelayanan Lalu Lintas Penerbangan (Certification Of Air Traffic Service Provider), sebagaimana tercantum dalam Lampiran Peraturan ini. Pasal 2 Direktur Navigasi Penerbangan melaksanakan pengawasan terhadap pelaksanaan Peraturan ini. Pasal 3 Peraturan ini berlaku sejak tanggal ditetapkan. SALINAN Peraturan ini disampaikan kepada : Ditetapkan di Jakarta Pada tanggal 25 April 2014 DIREKTUR JENDERAL PERHUBUNGAN UDARA, ttd HERRY BAKTI 1. Menteri Perhubungan 2. Sekretaris Jenderal, Inspektur Jenderal, Para Kepala Badan di lingkungan Kementerian Perhubungan; 3. Para Direktur di Lingkungan Ditjen Perhubungan Udara; 4. Para Kepala Otoritas Bandar Udara; 5. Para Kepala Bandar Udara di lingkungan Ditjen Perhubungan Udara; 6. Direktur Utama PT. Angkasa Pura I (Persero); 7. Direktur Utama PT. Angkasa Pura II (Persero); 8. Direktur Utama Perum LPPNPI. Salinan sesuai dengan aslinya KEPALA BAGMAN HUKUM DAN HUMAS ISRAFU^HAYAT Pembina (IV/a) ft9 199403 1 002

Lampiran I Peraturan Direktur Jenderal Perhubungan Udara Nomor Kp 248 TAHUN 2014 Tanggal : 25 April 2014 PETUNJUK TEKNIS BAGIAN 172-01 {STAFF INSTRUCTION PART 172-01) MENGENAI SERTIFIKASI PENYELENGGARA PELAYANAN LALU LINTAS PENERBANGAN {CERTIFICATION OF AIR TRAFFIC SERVICE PROVIDER) Revisi Tanggal REPUBLIK INDONESIA - KEMENTERIAN PERHUBUNGAN DIREKTORAT JENDERAL PERHUBUNGAN UDARA JAKARTA - INDONESIA

FOREWORD 1. PURPOSE: This Staff Instruction prescribes procedures to be used by DGCA to issue an Air Traffic Services (ATS) Provider Certificate and provide Continued Surveillance in accordance with CASR Part 172. 2. REFERENCES: This Staff Instruction should be used in accordance with the applicable Regulations. 3. REVISION: Revision of this Staff Instruction will be approved by the Director General of Civil Aviation.

TABLE OF CONTENTS FOREWORD TABLE OF CONTENTS CHAPTER I REGULATORY REQUIREMENT 4 1.1 Purpose and Scope of the SI 4 1.1.1 Purpose of the SI 4 1.1.2 Scope of the SI 4 1.2 Introduction to Air Traffic Services Regulatory Requirements 5 1.2.1 Operational Requirements 5 1.2.2 Assessing the Applicant 5 1.2.3 Regulatory Standards and Procedures for the Provision of ATS 5 1.2.4 Operations Manual 5 1.2.5 Preparation by DGCA Assessing Officers 6 1.3 Classification of Air Traffic Services 6 CHAPTER II APPROVAL PROCEDURES FOR AIR TRAFFIC SERVICE PROVIDERS 7 2.1 Approval Procedures for Air Traffic Service Providers - Flowchart 7 2.2 Initial Enquiries Regarding Application and Approval of Air Traffic Service Providers 8 2.2.1 Handling Initial Enquiries 8 2.2.2 When an ATS Provider Certificate Required 8 2.2.3 Documents Required for Application 8 2.2.4 Content of Operations Manual 8 2.2.5 Assessment and Approval Process 8 2.3 Approval Process 9 2.3.1 On Receipt of a Written Request Form from an Applicant 9 2.3.2 DGCA May Ask for a Demonstration of a Service 9 2.3.3 DGCA May Ask the Applicant for More Information 9 2.3.4 Matters to be Considered 9 2.3.5 Prepare a letter of approval and the Certificate 9 2.4 ATS Approved ATS Provider Certificate 10 2.4.1 Content of an ATS Approved Service Provider Certificate 2.4.2 Conditions to be Specified on the Certificate 10 2.4.3 Director General Approves an Application 10 2.4.4 Decision Timeframe 10 2.4.5 Grounds for Suspension or Cancellation of Approval 1 2.4.6 Return of Certificate if Approval Cancelled T 2.5 Issue of ATS Approved Provider Certificate 1 2.5.1 Authorised DGCA Officer Actions 1 2.6 Term of Air Traffic Service Provider Certificate T 2.7 Changes to Certificate 12 2.7.1 Replacement Certificate and Imposing and Varying Conditions on a Certificate 12

CHAPTER III APPROVED PROVIDER'S OPERATIONS MANUAL 13 3.1 Operations Manual to Contain or Refer to Information 13 3.1.1 Content 13 3.1.2 Reference to Other Documents 13 3.2 Organisational Structure and Functions 13 3.2.1 Organisational Chart 13 3.3 Proposed Air Traffic Services 13 3.3.1 Types of Proposed Services 13 3.3.2 Assessment of Standards 14 3.4 Information Necessary for Service Provision 14 3.4.1 Input Data 14 3.4.2 Output Data 14 3.4.3 Provider's Record Keeping System 15 3.5 Safety Management System 15 3.6 Security Program 15 3.7 Disseminating Information to Staff 16 3.8 Provider's Training and Checking Program 16 3.9 Commissioning New Facilities, Equipment and Services 16 3.10 Revision of the Operations Manual 16 CHAPTER IV SAMPLE DOCUMENTS 17 4.1 ATS Provider Application Form 18 4.2 Air Traffic Service Provider Certificate 19 4.3 Conditions of Approval for the ATS Provider Certificate 20 4.4 ATS Provider Certification Checklist 21

CHAPTER I REGULATORY REQUIREMENT 1.1 PURPOSE AND SCOPE OF THE STAFF INSTRUCTION (SI) 1.1.1 Purpose of the SI This is an internal DGCA procedure that is for the guidance of DGCA staff involved in assessing applications from organisations seeking Approval under the provision of CASR Part 172 to provide an Air Traffic Service. 1.1.2 Scope of the SI This SI is a part of the DGCA document set. It includes processes, flowcharts, forms, and certificate to aid DGCA officers assessing applications for Approval as an Air Traffic Service Providers. The SI consists of: a. Regulatory Requirements. b. Approval Procedures for Air Traffic Service Providers. c. Contents of an approved Air Traffic Service Provider's Operations Manual. d. Sample Documents sample forms and the Service Provider Certificate and Conditions. By adhering to the procedures set out in this SI, a standard and unified approach within DGCA, consistent with regulatory requirements, will be created and maintained when assessing and approving organisations as ATS Providers. This Staff Instruction may be made available to organisations seeking Approval under the provisions of CASR 172 to provide an Air Traffic Service.

1.2 INTRODUCTION TO AIR TRAFFIC REGULATORY REQUIREMENTS 1.2.1 Operational Requirements Operational requirements for the provision of Air Traffic Services specify that Providers are to: provide Air Traffic Services within the airspace which is the responsibility of DGCA Indonesia. Services are to be provided in accordance with CASR 170 and AC 170-02 for aircraft operating under Instrument Flight Rules and Visual Flight Rules; use approved procedures in the provision of Air Traffic Services; ensure only correctly trained, experienced and licensed staff provide Air Traffic Services, except that staff undergoing training may provide services under the direct supervision of a licensed controller; and maintain records in accordance with CASRs, ACs, and other relevant documents. 1.2.2 Assessing the Applicant In making applications for Approval, an organisation must clearly indicate which of these services the application covers. In assessing applications, DGCA officers must ensure that the applicant has the organisational structure, ATS facilities and equipment, appropriately licensed personnel, and the external data and coordination interfaces necessary to provide the nominated services. This will entail assessing officers working through the checklist provided herein to ensure that all of the regulatory requirements in CASR Part 172 and the AC Part 172-01 are covered in a systematic way. An Approval should not be given unless all regulatory requirements/standards have been assessed, and all items have been adequately addressed and met by the applicant. 1.2.3 Regulatory Standards and Procedures for the Provision of ATS The following standards and procedures are to be employed in the provision of Air Traffic Services: a. The Civil Aviation Safety Regulations. b. The standards in the AC 170-02. c. The standards in the AC 172-01. d. The procedures in ICAO Regional Supplementary Procedures (Doc 7030). e. The radiotelephony procedures set out in Parts 1 and 2 of the AIP. f. The standards for the procedures for aeronautical telecommunications set out in Vol. II of Annex 10 as varied by the AIP. 1.2.4 Operations Manual In making an application for Approval, prospective Air Traffic Service Providers are required to provide DGCA with an exposition which demonstrates compliance with the provisions of CASR 171. The exposition should include a copy of the ATS Provider's proposed Operations Manual. This initially forms the basis of the submission for Approval. The Operations Manual may vary depending upon the type of service and its complexity.

Prospective ATS Providers will need to establish procedures that address the regulatory requirements in CASR Part 172, as well as the standards in the AC 172-01. Note: The contents of the Operations Manual are specified in AC 172-01. 1.2.5 Preparation by DGCA Assessing Officers When preparing for the assessment of an application for Approval as an ATS Provider, DGCA Assessing Officers should be thoroughly familiar with the provisions of the following documents: a. CASR Part 172; b. CASR Part 170; c. Advisory Circular 172-01; d. Advisory Circular 170-02; e. ICAO Regional Supplementary Procedures (Doc 7030); and f. other relevant documents. 1.3 CLASSIFICATION OF AIR TRAFFIC SERVICES Air Traffic Services comprise three separate services, identified as follows: a. The Air Traffic Control (ATC) Service, which is sub-divided into three distinct types of control functions, as follows: 1) Approach Control. 2) Aerodrome Control. 3) Area Control. b. The Flight Information Service; and c. The Search and Rescue (SAR) Alerting Service.

CHAPTER II APPROVAL PROCEDURES FOR AIR TRAFFIC SERVICE PROVIDERS 2.1 APPROVAL PROCEDURES FLOWCHART FOR AIR TRAFFIC SERVICE PROVIDERS APPLICANT MUST PROVIDE Application in writing Completed application form Name and address of organisation making application Registered address and NPWP Names and addresses of its officers, Organisation chart Location/s of operations Air Traffic Services covered by the application Hours of operation Commencement date Facilities installed and operative? Have qualified staffs been engaged? Can services be demonstrated? Operations Manual of the Service Provider Agreements with other bodies ACKNOWLEDGE RECEIPT OF APPLICATION (WITHIN 7 DAYS) Certification processes ( within 90 days ), as follows Application checked for completeness Checked for compliance against Regulation If necessary, checked locations Face-to-face meeting Assessment processes No Letter stating reasons for rejection from DGCA Approval Letter from DGCA to grant an Air Traffic Service Provider Certificate Registration and issue certification of Air Traffic Service Provider I Air Traffic Service Provider Certificate of Approval submitted to the ATS Provider

2.2 INITIAL ENQUIRIES REGARDING APPLICATION AND APPROVAL OF AIR TRAFFIC SERVICE PROVIDERS 2.2.1 Handling Initial Enquiries When handling enquiries from a prospective applicant, consideration should be given to the items in paragraphs 2.2.2 to 2.2.6 below. 2.2.2 When is an Air Traffic Service Provider Certificate Required? An Air Traffic Service Provider Certificate is required by any organisation which provides Air Traffic Services. 2.2.3 Documents Required for Application An application for a Certificate to operate as an ATS Provider must be made in writing. The following details and documents are required to be submitted with an application: The applicant's registered address Tax Identification Number and the names and addresses of its officers. Establishment Act of the Business Entity issued by the appropriate Minister. Business Address on Organisation Letterhead. A list of the Air Traffic Services for which the application is being made. A statement of the location from which each service is to be provided. The airspace in which each service will be provided, if the service is to be provided within particular airspace. The aerodrome for which the service will be provided, if the service is to be provided for an aerodrome. The hours of operation during which each Air Traffic Service is proposed to be available. The proposed commencement date for service provision. An exposition showing the applicant meets the requirements for issue of a Certificate. A copy of the organisation's draft Operations Manual for certification assessment and retention. 2.2.4 Contents of the Operations Manual The required contents of an Operations Manual of an approved Provider are specified in Chapter 2, AC 172-01. 2.2.5 Assessment and Approval Process An initial desk-top assessment will be directed toward establishing to what extent the requirements specified in CASR Part 172 and AC 172-01 have been met. After the initial desk-top assessment of the application and examination of the Operations Manual have been completed, the DGCA Assessment Officer should, if necessary, invite the applicant to a meeting to clarify requirements.

After the initial assessment is undertaken, the face-to-face meeting with the applicant should be directed at explaining any areas of shortfall in the applicant's Operations Manual and indicating what further supporting information must be provided before DGCA can continue with the assessment. If appropriate, where the applicant has already established the facilities and equipment, and personnel, including licensed ATS personnel necessary for service provision, DGCA should raise with the applicant the possible requirement for the proposed services to be actually demonstrated. 2.3 APPROVAL PROCESS 2.3.1 On Receipt of a Written Request Form from an Applicant On receipt of a written application, the following process should be performed: Record the request. Raise a new file and attach the applicant's correspondence to the relevant file. Undertake a complete and thorough desk-top assessment of the applicant's Operations Manual for compliance against all the applicable requirements and standards of Part 172 and the AC 172-01. Use the Checklist Form at Section 4.7 to record the results of this assessment. 2.3.2 DGCA May Ask for Demonstration of a Service When considering an application for Approval, DGCA may, in writing, ask the applicant to demonstrate procedures or equipment to determine whether the applicant can properly provide the Air Traffic Services. DGCA should decide on the necessity for a demonstration of the proposed service(s). A demonstration will normally be requested if the necessary facilities are in place. If an applicant has not established the necessary facilities, equipment and personnel, final approval will normally be withheld until these are in place and the service can be demonstrated to DGCA's satisfaction. 2.3.3 DGCA May Ask the Applicant for More Information If it is necessary to require the applicant to provide more information or further documentation, the applicant should be advised in writing, clearly stating the information that is required and the date by which it is required. 2.3.4 Matters to be Considered In assessing and making a decision on any application, DGCA may take into account: Anything in the application; Anything in any other document submitted by the applicant; The results of any demonstration of a service; or Anything which DGCA has in its records about the applicant. If an applicant has previously been approved as an ATS provider, and the 9

Approval was cancelled by DGCA for contravention of the Act or the Regulations, the applicant must provide any available evidence that demonstrates that the applicant could now properly provide the Air Traffic Services applied for. 2.3.5 Prepare a Letter of Approval and the Certificate If the application is to be approved, the appropriate DGCA Officer is to prepare the letter of approval and the ATS Approved Service Provider Certificate (see Section 4.2 and 4.3) for the DGCA Delegate's approval. 2.4 ATS APPROVED SERVICE PROVIDER CERTIFICATE 2.4.1 Content of an ATS Approved Service Provider Certificate An ATS Approved Service Provider Certificate is to include the following details: The identity of the approved Provider (name, address, and NPWP registered office). A list of those ATS services approved under the Certificate, together with details of their location, and aerodrome and airspace, as applicable. The date of approval of the Certificate. Conditions on the Certificate; including the condition that DGCA has the authority to undertake a safety oversight activity of the Provider's operation at any time. Note: Samples of the Certificate and Conditions are provided in Section 4.2 and 4.3. 2.4.2 Conditions to be Specified on the Certificate As a minimum, the following conditions are to be specified on the certificate: DGCA's authority to undertake safety audits. DGCA's authority to cancel the Certificate where DGCA considers that it is justified from an aviation safety perspective. 2.4.3 Director General Approval for an Application If an organisation has applied for a Certificate as an ATS Approved Provider and the applicant has demonstrated compliance, DGCA must grant an approval if: The applicant complies with the standard in CASR 172; and No provision in regulations prevents DGCA from approving the applicant, or makes the applicant ineligible for the Approval. However, the application would be refused, where an Air Traffic Service has already been approved by DGCA and is operating in the same airspace or the same aerodrome, as that service which the applicant proposes to provide. 2.4.4 Decision Timeframe 10

DGCA must make a decision about an application within six months after receipt of the application. If a decision is not taken within six months, Regulation 172.265 provides that DGCA is taken to have refused the application. Note that the six months assessment period may be extended if DGCA has made a request under Regulation 172.240 for further information. The time between when DGCA makes the request and when the applicant provides the requested information to DGCA, is not included in the assessment period. 2.4.5 Grounds for Suspension or Cancellation of Approval DGCA may suspend or cancel an Approval if the relevant Regulation is breached. DGCA is to justify the suspension or cancellation. DGCA is to provide written notice of intent to cancel a Certificate to a Certificate Holder. The notice is to include the reasons for the cancellation. The issue of a Show Cause Notice by DGCA, requires the Certificate Holder to take corrective actions in accordance with the applicable regulations. The Corrective Action Plan shall be provided not more than 14 days after the date stated in the Show Cause Notice. 2.4.6 Return of Certificate if Approval Cancelled If DGCA cancels the Approval of an ATS Provider, the return the Certificate to DGCA. Certificate Holder must 2.5 ISSUE OF ATS APPROVED PROVIDER CERTIFICATE 2.5.1 Authorised DGCA Officer's Actions Following assessment of the application and completion of the compliance/entry control checklist ATS Provider Certification Checklist (see Section 4.4) and the ATS Provider has been determined to be eligible to be approved, the ATS Approved Provider Certificate is to be forwarded to the responsible DGCA Officer for signature. DGCA is to retain: Correspondence with the applicant. A copy of the approved Provider's Operations Manual. A copy of the Air Traffic Service Provider Certificate. The following documents are sent to the applicant: DGCA's Approval Letter. The approved Air Traffic Service Provider Certificate. 2.6 TERM OF AIR TRAFFIC SERVICE PROVIDER CERTIFICATE ll

Certificates will not have an expiry date included. However, a date for the review of any conditions placed on the Certificate is to be included. That date will be dependent on the type and extent of the conditions that are initially placed on the Certificate, but will not be in excess of three years after the date of original issue of the Certificate. 2.7 CHANGES TO CERTIFICATE 2.7.1 Replacement Certificate and Imposing and Varying Conditions on a Certificate If it is necessary to vary anything on a Certificate, a Replacement Certificate should be issued. This will be the case where: An approved Provider wants to vary its Certificate. There is a change in the service(s) provided by an approved Provider, and DGCA has approved the change. DGCA considers it necessary to add a condition or to vary any of the conditions on a Certificate. Such a proposed change to an approved service is to be processed by DGCA as a variation of the original Approval. This is to be authorised by re-issue of the Air Traffic Service Provider Certificate with the amended or additional entries covering: The change to a service. A new service. The change to a condition. A new condition. It will be necessary for the approved Provider to enclose any variation documentation to support the amendment to its Operations Manual and provide a Safety Case to show there will be no reduction in existing safety levels. 12

CHAPTER III APPROVED PROVIDER'S OPERATIONS MANUAL 3.1 OPERATIONS MANUAL TO CONTAIN OR REFER TO INFORMATION 3.1.1 Content The content of an Operations Manual must meet the requirements specified in Subpart C of CASR Part 172 and the AC 172-01. 3.1.2 Reference to Other Documents It is DGCA policy that a requirement to include particular information in an applicant's Operations Manual may be satisfied by making reference in the Manual to that information in another document held by the applicant. 3.2 ORGANISATIONAL STRUCTURE AND FUNCTIONS 3.2.1 Organisational Chart An organisational chart of the Service Provider in the Operations Manual should include: A chart or other means of describing the Provider's organisational structure. The names and positions of the principals (officers) of the organisation. A description of the chain of command to be established by the Provider with a statement of the duties and responsibilities of the positions within the organisational structure. A statement showing how the Provider determines the number of operational staff required, including the number of operational supervisory staff. A clear indication that SMS responsibility rests with senior management. 3.3 PROPOSED AIR TRAFFIC SERVICES 3.3.1 Types of Proposed Services The Operations Manual should include: A statement setting out the Air Traffic Services, and the related functions, that the Provider proposes to perform under CASR Part 172. The proposed hours of operations of each service. The airspace within which each service is to be provided - by reference to the relevant aeronautical chart. The specific location or locations in the case of distributed facilities, from which each service is to be provided. If the proposed service is an Air Traffic Service for a controlled aerodrome: o A chart of the maneuvering area of the aerodrome showing all runways, taxiways, parking areas, etc. 13

o o Extract(s) from the Aerodrome Emergency Plan (AEP) relevant to the ATS functions. A copy of the procedures as set out in the Aerodrome Manual for preventing unauthorised entry of persons or property onto the movement area of the aerodrome. o A copy of the procedures as set out in the Aerodrome Manual for the control of surface vehicles on or in the vicinity of the manoeuvring area. A duty statement including the functions, responsibilities, and hours of operation, of each operating position. 3.3.2 Assessment of Standards It is important that DGCA compliance officers make an assessment of the relevance and adequacy of the standards to be provided for each service. In particular, attention should be given to organisational structure and the provision of sufficient operational staff, both at supervisory and functional level, to provide the proposed services. 3.4 INFORMATION NECESSARY FOR SERVICE PROVISION 3.4.1 Input Data The Operations Manual should include a description of the arrangements made or proposed to be made by the applicant to ensure that it has, and will continue to receive, the information necessary for providing each service. This requirement includes information that is both internally and externally sourced. The description should nominate the information requirement, its use in service provision, its source, and the means of its transfer, receipt and display. Examples of Data Sources Examples of data sources normally required are: AIS AFTN NOTAM Flight notification Meteorological information Meteorological warning service Voice coordination with adjacent Part 172 Providers Information on aerodrome conditions and the operational status of facilities and navigation aids Aerodrome works and administration coordination Fire Fighting Service coordination Local and remote surveillance data Information on unmanned free balloons Information on Unmanned Aerial Systems (UAS) activity Information concerning volcanic activity 14

Information concerning radioactive material and toxic chemical clouds. 3.4.2 Output Data The Operations Manual should include a description of the arrangements made or proposed to be made by the applicant to ensure that it can, and will continue to be able to provide the information in relation to its Air Traffic Services to other organisations whose functions reasonably require that information (e.g. other ATS units and centres). The description should nominate the information requirement and recipient, and the means of its transfer. Examples of data recipients could normally be: AIS Adjacent Part 172 Providers Aerodrome administration Fire Fighting Service The Part 171 Provider Other Government Agencies. 3.4.3 Provider's Record Keeping System The Operations Manual must include the requirement for a Record Keeping System that covers identification, collection, indexing, storage, security, maintenance, access and disposal of records necessary for the provision of Air Traffic Services. The Records Systems must provide an accurate chronicle of ATS activities for the purpose of reconstruction of events for air safety investigation or for system safety analysis within the Safety Management System. The type of records to be kept, and the time of retention are specified in 172-01. AC Assessing officers should ensure that the applicant has a System in place that will cover all the record types required, including operational voice and surveillance data records. 3.5 SAFETY MANAGEMENT SYSTEM The Safety Management System (SMS) described in the Operations Manual and adopted by the organisation must comply with the State Safety Program and all the standards encompassed in AC 172-01. The SMS is an important component of an ATS Provider's operation. It should be an indication of the safety culture of an organisation as it defines the policies, procedures and practices for managing the safety of the provision of ATS, and managing any changes in the provision of the ATS. 15

The SMS should include the processes proposed for management review of its SMS, and the implementation of corrective action as necessary. 3.6 SECURITY PROGRAM An applicant must establish a Security Program that minimises the risk of unauthorised access, entry by animals or malicious damage to a service or facilities. The Security Program is to be in accordance with the standards in the National Aviation Security Plan, CASR 172.155, and Chapter 8 of AC 172-01 and the guidance in ICAO Doc 9985. 3.7 DISSEMINATING INFORMATION TO STAFF The Operations Manual must contain a description of the procedures and documentation to be adopted and used by the applicant to provide its staff with information on: The relevant standards for service provision, including the CASR Part 170, AC 170-02, AC 172-01, and other relevant standards. Operational instructions to staff. Operational changes that are to be conveyed to staff. 3.8 PROVIDER'S TRAINING AND CHECKING PROGRAM The Operations Manual must detail a Provider's Training and Checking Program and provide assurance that any individual performing any ATS functions is competent to perform that function. It is important that the applicant's proposed Training and Checking Program covers all elements in Chapter 45 of AC 172-01 and requirements of CASR Parts 69 and 143. 3.9 COMMISSIONING NEW FACILITIES, EQUIPMENT AND SERVICES Under this requirement, the Operations Manual should describe the processes for the installation, commissioning and transition into service phases of new facilities, equipment and services, and provide evidence, arguments and assumptions in the form of a Safety Case for acceptance of the operational performance and the safety of the facility, equipment, procedure or service. The Safety Case must establish that the design objectives in respect to performance and safety have actually been met, or if not met, that appropriate corrective actions and/or risk mitigation has been implemented to ensure there will be no reduction in levels of safety. 3.10 REVISING THE OPERATIONS MANUAL 16

An applicant must include in the Operations Manual, the processes proposed for the preparation, authorisation and issue of amendments to its Operations Manual. The Operations Manual must be a controlled document and therefore, the amendment process must similarly be controlled. 17

4.1 ATS Provider Application Form CHAPTER IV SAMPLE DOCUMENTS '& ^ SECTION A: APPLICANT DETAILS Air Traffic Service Provider Application Reference: CASR Part 172 Person/Company Name Registered Address NPWP Names of Officers if Company Postal Address Telephone No. SECTION B: OPERATIONAL DETAILS TO BE PROVIDED TO DGCA WITH APPLICATION Location of proposed Part 172 operation: Air Traffic Service(s) to be provided: Daily hours of service: Proposed commencement date: Organization Chart: Provided Yes / No Operations Manual: Provided Yes / No Are facilities installed and operative? Yes / No Has staff been engaged? Can services be demonstrated? Documentary evidence in support of all matters in this application may be requested SECTION C: LIST OF NON-COMPLIANCES WITH CASR 172 Reference (Attach list if insufficient space) Details and reason for non-compliance SECTION D: DECLARATION On behalf of I hereby apply for DGCA approval as an ATS Approved Provider. Signed: My authority to act on behalf of the applicant is: Name of person making the declaration: Date: Form no 172001 03/2010 ATS - application - air traffic service provider application 18

4 2 Air Traffic Service Provider Certificate ASk ^ Air Traffic Service Provider Certificate Certificate No. Civil Aviation Safety Regulation Part 172 This certificate authorizes to provide the following Air Traffic Services at {enter location}: {enter listing of approved services} This Certificate is issued under Civil Aviation Safety Regulation Part 172. The operation and maintenance of the approved services is subject to the Aviation Act No.1 Year 2009, the Civil Aviation Safety Regulations, and any relevant direction issued by the Directorate General of Civil Aviation, including the conditions on the reverse of this Certificate. Date of effect of Certificate: {insert date of commencement of approval here} This Certificate remains in force until surrendered, suspended or cancelled. {insert here name and position of the DGCA Authorized Officer} {inserthere date of signature by the Delegate} 19

4.3 Conditions of Approval for the Air Traffic Service Provider Certificate Air Traffic Service Provider Certificate Approved Service Provider {insert name} Address {insert address of Service Provider} Conditions ofapproval Level of service and operation of service must be in accordance with the Operations Manual of the approved Service Provider. The approved Service Provider is subject to a regular DGCA audit of service provision. Any change to the services provided must be referred to DGCA for approval. DGCA has the power to cancel an ATS Provider Approval in accordance with the CASR 172. 325 process, if required. The above conditions will be reviewed at a period not greater than three years from the date of original issue. 20

4 4 ATS Provider Certification Checklist ATS Provider Certification Checklist Reference: CASR Part 172 and AC Part 172 i& ^ The processing officer(s) must complete this checklist to ensure that each step of the application process is completed priorto the issuing of a Certificate to an ATS Provider. Tick each box to indicate the satisfactory completion of the assessment task. Also note the date of completion of each task against the box. Sign and date this form and file it on the appropriate file when the process is completed. File Raised File No. Compliance with AC Chapters 1 Acknowledgment of application within 7 days I 1 2 2 Face-to-face meeting L-I 3 4 3 Operations Manual provided by applicant L.1 5 6 4 Application checked for completeness 1 I 7 8 5 Documentation assessed against CASR Part 172 and AC 172 I 1 9 10 6 Demonstration of service required/not required, and provided/not provided by applicant LJ 11 12 7 Applicant assessed as being able toprovide a service 1 1 13 14 8 Certification granted/declined LJ Compliance with CASR Part 172 9 Applicant advised ofoutcome LJ (ref) 10 Certificate issued LJ 11 Operations Manual acknowledged and returned LJ 12 Notify Compliance Division of new Provider to be included in their audit schedule LJ 13 New Provider listed onthedgca web page LJ 14 Signed: Date: / Name and Position: Assessing Officer DIREKTUR JENDERAL PERHUBUNGAN UDARA, ttd HERRY BAKTI Salinan sesuai dengan aslinya KEPALA BAGIAN HUKUM DAN HUMAS ISRAFU1HAYAT»^eybiili (IV/a) NIP. 1968J^9 199403 1002 77b" 21