ARN: 19XX69 DOE. Jane 01 December 2014 Page 4 of 14 XII
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ARN: 19XX69 DOE. Jane 01 December 2014 Page 1 of 14 ARN: 19XX69 I DOE. Jane 01 December 2014 Page 2 of 14 COMMONWEALTH OF AUSTRALIA CIVIL AVIATION SAFETY AUTHORITY II FLIGHT CREW LICENCE III Licence No: 19XX69 IV Name: Jane DOE IVa Date of Birth: 0 3 August 19XX VI Nationality: AUSTRALIAN VII Signature of Holder…………………………………………………. VIII Granted in accordance with the Civil Aviation Safety Regulations and subject to any conditions and limitation expressed therein and to conditions at item XII. IX This licence shall remain in force for the holder’s lifetime unless revoked, suspended or varied. The privileges of the licence shall be exercised only if the holder has a valid medical certificate for the required privilege. JaneDoe Jim Jones X 24 Nov 2011 JIM JONES Delegate of the Civil Aviation Safety Authority XI Stamp Issued without erasure or correction. Any removal of printed background may indicate alterations. ARN: 19XX69 XII DOE. Jane 01 December 2014 Page 3 of 14 XII Flight Crew Licences and Category Ratings: Licence Class Name ARN: 19XX69 Issue Date PRIVATE PILOT LICENCE AEROPLANE DD MMM YYYY STUDENT PILOT LICENCE DD MMM YYYY ………………………………………………………. End of Licence List DOE. Jane 01 December 2014 Page 4 of 14 Aircraft Ratings and Endorsements: Class Ratings Issue Date SEA DD MMM YYYY MEA DD MMM YYYY Design Feature Endorsements Issue Date RUA DD MMM YYYY MPPCA DD MMM YYYY ………….…………………………………………………… End of Aircraft Ratings / Endorsements List Issued without erasure or correction. Any removal of printed background may indicate alterations. Issued without erasure or correction. Any removal of printed background may indicate alterations. X X 31/07/14 X IAP3D-------------- X MEA SEA IAP2D AERO-------------- X Valid To DD/MM/YY ARN: 19XX69 XII Page 7 of 14 ARN: 19XX69 DOE. Jane DOE. Jane 01 December 2014 01 December 2014 Issued without erasure or correction. Any removal of printed background may indicate alterations. Issued without erasure or correction. Any removal of printed background may indicate alterations. Signature DD MMM YYYY DD MMM YYYY Issued By Name / ARN Issue Date SEA MEA Valid To DD/MM/YY Night VFR Rating: Endorsements Operational Ratings and Endorsements Ratings 01 December 2014 Page 5 of 14 EEEndorsements Issue Date DD/MM/YY 01 December 2014 XII Initial Issue - Aircraft Ratings / Operational Ratings and Endorsements / Design Feature and Flight Endorsements AExaminer AExaminer AInstructor AInstructor Signature DOE. Jane X A.N.Examiner 23XX45 A.N.Instructor 12XX34 A.N.Instructor 12XX34 Issued By Name / ARN DOE. Jane Issued without erasure or correction. Any removal of printed background may indicate alterations. IR--------------------------------- Issued without erasure or correction. Any removal of printed background may indicate alterations. 15/07/13 X TWU---------------- Endorsements ARN: 19XX69 23/06/13 X Ratings XII 18/06/13 EEEndorsements Issue Date DD/MM/YY XII Initial Issue - Aircraft Ratings / Operational Ratings and Endorsements / Design Feature and Flight Endorsements ARN: 19XX69 Page 6 of 14 Operational Ratings and Endorsements Reserved …………………………………………………………………………. End of Operational Ratings /Endorsement List Issued without erasure or correction. Any removal of printed background may indicate alterations. Page 8 of 14 ARN: 19XX69 XIII DOE. Jane 01 December 2014 Page 9 of 14 ARN: 19XX69 Conditions/Licence Remarks: DOE. Jane XIV 01 December 2014 Page 10 of 14 Reserved English Language Proficiency: Level 4 Valid until dd mmm yyyy Radiotelephony Privileges: The holder of this licence has demonstrated competence to operate R/T equipment on board aircraft in English. Medical Certificate The holder must not perform a duty authorised by the licence unless the holds a current medical certificate that is appropriate to the licence. The conditions of the holder’s medical certificate must also be observed. ASIC/AVID The licence holder must carry at all times a valid photo identification when exercising the privileges of the licence. …………………………………………………………………………. End of Conditions /Remarks List Issued without erasure or correction. Any removal of printed background may indicate alterations XII Page 11 of 14 DOE. Jane 01 December 2014 Page 12 of 14 Issued without erasure or correction. Any removal of printed background may indicate alterations. Valid To DD/MM/YY PC / FR Date DD/MM/YY Flight Review and Proficiency Check - Aircraft Ratings and Operational Ratings XII Issued without erasure or correction. Any removal of printed background may indicate alterations. Issued By Name / ARN Signature ARN: 19XX69 Ratings 01 December 2014 AInstructor A.N.Instructor 12XX34 FR MEA-------------------------------------------15/07/13 15/07/15 AInstructor A.N.Instructor 12XX34 FR MEA-------------------------------------------16/02/13 16/02/15 AInstructor A.N.Instructor 12XX34 FR SEA--------------------------------------------15/0213 15/02/1 Issued By Name / ARN Ratings Valid To DD/MM/YY DOE. Jane PC / FR Date DD/MM/YY Flight Review and Proficiency Check - Aircraft Ratings and Operational Ratings Signature ARN: 19XX69 Issued without erasure or correction. Any removal of printed background may indicate alterations ARN: 19XX69 DOE. Jane 01 December 2014 Page 13 of 14 List of Abbreviations: Aircraft Category A H G AS PL GL Aeroplane Helicopter Gyroplane Airship Powered Lift Glider Recreational Pilot Licence Endorsements RPNA RPFR RPCA RPCT Navigation Flight Radio Controlled Airspace Controlled Aerodrome Aircraft Class Rating SEA MEA SEH SEG Single Engine Aeroplane Multi Engine Aeroplane Single Engine Helicopter Single Engine Gyroplane Operational Ratings IR PIFR NVFR NVISR LLR AAR FIR SIR FER Instrument Rating Private Instrument Rating Night VFR Rating Night Vision Imaging System Low Level Rating Aerial Application Rating Flight Instructor Rating Simulator Instructor Rating Flight Examiner Rating Endorsements on Operational Ratings - Aircraft Category Endorsement on an Operational Rating A H G AS PL SEA MEA SEH MEH Aeroplane Helicopter Gyroplane Airship Powered Lift Single Engine Aeroplane Multi Engine Aeroplane Single Engine Helicopter Multi Engine Helicopter - Instrument Rating IAP2D IAP3D NGTA NGTH NGTG Instrument Approach 2 dimensional Instrument Approach 3 dimensional Night Aeroplane Night Helicopter Night Gyroplane ARN: 19XX69 DOE. Jane 01 December 2014 Page 14 of 14 - Flight Instructor G1 G2 G3 MCT TRT META DFT IRT NVT LLT AATD AATN FIT METI Grade 1 Grade 2 Grade 3 Multi Crew Training Type Rating Training Multi Engine Aeroplane Training Design Feature Training Instrument Rating Training Night VFR Training Low Level Rating Aerial Application Rating Training - Day Aerial Application Rating Training - Night Flight Instructor Rating Training Multi Engine Aeroplane Class Rating Instructor Training - Flight Examiner Rating PPLT CPLT ATPLT MECT TRFT IRFT NVFT FIRFT ELPA Private Pilot Flight Test Commercial Pilot Flight Test Air Transport Pilot Flight Test Multi Engine Class Flight Test Type Rating Flight Test Instrument Rating Flight Test Night VFR Flight Test Flight Instructor Rating Flight Test English Language Assessment - Simulator Instructor Rating (see Flight Instructor) Aircraft Design Feature Endorsements TWU RUA RUH SKIL MPPCA GTE MECLT PXS FLP FLH FLAG Tail wheel Undercarriage Retractable Undercarriage Aeroplane Retractable Undercarriage Helicopter Ski Landing Gear Manual Propeller Pitch Control Gas Turbine Engine Aeroplane Multi Engine Centreline Thrust Pressurisation System Floatplane Floating Hull Float Alighting Gear Miscellaneous PC FR Proficiency Check Flight Review issued without erasure or correction. Any removal of printed background may indicate alterations issued without erasure or correction. Any removal of printed background may indicate alterations
