Operational Approvals Application
Instructions and advice for completing this Application Form
Note: The CAA Standard Rate hourly charge applies.

Refer to Advisory Circular AC91-Ops1 for the instructions to complete this application.

The charges associated with the operational approvals will be invoiced to the applicant.

Applications must be submitted to CAA not less than 28 days prior to the date required.

To reduce time and costs, this form is intended to be revised for additional applications after the initial
approvals for an aircraft type.
Brief Details
Make:
Model:
Single aircraft
Application Type:
Multiple aircraft
(Complete Appendix A)
New Application
Change being made:
Revision History
Revision No:
CAA Work Request No:
Date:
(To be completed by the CAA)
Part A – Details of Applicant
Name of Operator:
Client ID No. (if known)
Address for Service: Civil
Aviation Act, s8, requires applicants to
provide an address for service (ie, a
physical address) and to promptly notify
the Director of any changes.
Tel:
Fax:
Email:
Fax:
Email:
Postal Address: (If
different from Address for
Service.)
Tel:
Person or organisation who can be contacted for further information concerning this application:
Name:
Designation:
Address:
Tel:
Page 1 of 15
Mob:
Email:
CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Approvals Sought: (Check those required)
RVSM
ILS Cat II
ILS Cat III
180 min
210 min
RNP 10
RNAV 5
RNAV 2
RNAV 1
RNP 4
RNP 2
Basic RNP 1
Advanced RNP
EDTO:
120 min
240 min
Navigation
RNP APCH
RNP AR Ops
RF Legs
Baro VNAV
LPV
FANS 1/A
ADS-B Out
CASA CAO 82.5
EASA AMC 20-24
RTCA DO-260A
RTCA DO-260B
ADS-C
TBD
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CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Part B – Aircraft and Equipment Details
Make:
Model:
Serial No:
Line No:
Variable No:
Registration Mark:
CAA Aircraft ID:
Mode S Code (hex):
C8XXXX
Aircraft History:
New
Used
Previous Registration:
Previous Operator:
State / Country:
For multiple aircraft of the same make and model complete the continuation sheet in Appendix A.
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CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Aircraft Documentation
(Insert document number, revision / date and reference information)
Flight Manual:
Air No:
Manufacturer No:
Rev:
RVSM Approvals
AFM Reference
SIL / SB
Navigation Approvals
AFM / Approval Doc References
AFM / Approval Doc References
AFM / Approval Doc References
ADS-B Approvals
Approvals held
Nil
AFM Reference
Relevant Approval Doc
ADS-C Approvals
Aircraft ELA
Aircraft Software Configuration List
Maintenance Planning Document
Aircraft Maintenance Manual
IPC
Wiring Diagram Manual
Structural Repair Manual
Configuration Deviation List
MMEL
Operator MEL / DDPG
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CAA 24091/07
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Operational Approvals Application
Aircraft Equipment Details
Communications Systems
(Insert Make, Model & P/N)
Qty installed
VHF Model
0
HF Model
0
SATCOM Model
SATCOM Data
0
SATCOM Voice
0
Is SCV integrated to audio, CVR and FDR systems?
No
Is an Exemption against §91.519 held for this aircraft?
No
Exemption No:
Navigation Systems
Qty installed
Inertial Reference System
Model
0
Part No
Air Data Computers Model
Model
0
Part No
GNSS
Model
0
Part No
DME
Model
0
Part No
Flight Management Computer
Model
0
Part No
Software Version
Flight Control Computer
Model
0
Part No
Software Version
Mode Control Panel
Model
Part No
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CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Pitot Static Probes
Model / Part No
0
Angle of Attack Vanes
Model / Part No
0
Surveillance Systems
Transponder 1
Model
Mode S
0
Part No
Software Version
ELS
EHS
Extended Squitter
Transponder 2
Model
Mode S
0
Part No
Software Version
ELS
Page 6 of 15
EHS
Extended Squitter
CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Part C – Continued Airworthiness
Maintenance Organisation
Contact Details:
Name:
Phone:
Mobile:
Email:
Maintenance facilities to be used:
Procedures for managing maintenance providers:
Part 43 specified maintenance completed:
Part 43 App B Radio Station Inspection
Part 43 App D Altimeter Systems Tests & Inspections
Part 43 App E ATC Transponder Tests & Inspections
Comments:
Maintenance Practices
(Insert document number, revision / date and reference information)
Maintenance schedule
Configuration management
Modifications / Repairs
Maintenance Practices
Use of BITE
Static System Maintenance
Skin Waviness Checks
Non-Compliant Aircraft
Notification Procedure (maintenance)
Notification Procedure (operations)
Notification Procedure (CAA)
Corrective Action Procedures
Maintenance Training
Test Equipment
Documentation
RVSM Test Equipment
Accuracy (0.01% or 4:1)
Calibration Schedule
Audit Programme
Maintenance Practices
Comments:
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CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Part D – Operational Training and Competency
Contact Details:
Name:
Phone:
Mobile:
Email:
Training programme submitted:
RVSM
PBN: RNAV & RNP
FANS 1/A
ADS-B
ADS-C
Operator Practices and Procedures - RVSM
Flight Planning
Pre-Flight
Procedures prior to RVSM airspace entry
In-Flight Procedures
ATC Phraseology
NAT Airspace Procedures
Verification / Monitoring Programme
Operator Practices and Procedures – PBN: RNAV & RNP
Flight Planning
Pre-Flight
Procedures prior to RNP airspace entry
In-Flight Procedures
ATC Phraseology
Special Airspace Procedures
Training
Operator Practices and Procedures – RNP / FANS 1/A
Flight Planning
Pre-Flight
Procedures prior to RNP airspace entry
In-Flight Procedures
ATC Phraseology
Special Airspace Procedures
Training
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Operational Approvals Application
Operator Practices and Procedures – ADS-B / ADS-C
Flight Planning
Pre-Flight
Procedures prior to ADS-B airspace entry
In-Flight Procedures
ATC Phraseology
Special Airspace Procedures
Training
Crew training completed:
Comments:
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CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Part E – Applicants Declaration
I am signing this form as:
A Senior Person in a Part 119 Certificated operator.
Owner / operator of an aircraft engaged in Part 91 operations only.
Agent or representative of an OWNER / OPERATOR of an aircraft engaged in Part 91 operations only.
Giving false or misleading information is an offence under the regulations.
1. I declare that the information provided in this application form is true and correct.
2. I understand that the information provided in this application will allow CAANZ to calculate an estimate
for service for processing this application.
3. I understand and agree that the cost estimate may change, and processing the application may be
delayed if:

the application does not accurately and completely identify my/our requirements; or

the details in this application are subsequently changed; or

adequate supporting documentation has not been provided.
4. I understand and agree that for CAANZ to proceed with this application, I must:

accept the cost estimate,

forward the prescribed payment; and

forward all supporting documentation to CAANZ.
5. If I am signing this application as an agent, I declare that I have obtained the necessary Power of
Attorney authorising me to sign on behalf of the applicants.
Name:
Date:
There is no signature required on this form; the presence of the name of the individual in this field is deemed
to be a signature.
Part F – Submitting Your Application
Have you attached all required documentation as indicated throughout the application? All supplemental
information should be in an electronic format.
After reviewing your application, CAANZ will advise you if any additional information is required.
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CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Part G – CAA Assessment
1. Airworthiness:
a. RVSM:
i.
T
he aircraft meets the airworthiness requirements specified in AC 91-4
approval for RVSM operations.
ii.
Aircraft has dual independent communications:
VHF
HF
HF + SCV
iii.
Aircraft meets the requirements for:
Being assessed.
iv.
Aircraft inspection required:
No
v. Inspection sheet raised:
b. The aircraft meets the airworthiness requirements specified in AC 91-XX for the
following navigation operations:
i. RNP 10 (RNAV 10)
ii. RNAV 5 (BRNAV)
iii. RNAV 2
iv. RNAV 1 (PRNAV)
v. RNP 4
vi. RNP 2
vii. Basic RNP 1
viii. RNP 0.3
ix. RNP APCH
x. RNP AR Operations
xi. Baro VNAV
xii. LPV
xiii. RF legs
xiv. FANS 1/A
xv. Inertial only navigation time for RNP 10:
x.x hours
xvi. Inertial only navigation time for RNAV 5:
x.x hours
Conditions / limitations / comments:
c.
The aircraft meets the airworthiness requirements specified in AC 91-XX for ADS-B
operations in airspace with the following requirements:
i. CASA CAO 82.5
ii. EASA AMC 20-24
iii. RTCA DO-260A
iv. RTCA DO-260B
Conditions / limitations / comments:
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CAA 24091/07
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Operational Approvals Application
d. The aircraft meets the airworthiness requirements specified in AC 91-XX for ADS-C
operations in airspace with the following requirements:
i. TBD
Conditions / limitations / comments:
2. Continued Airworthiness:
a. The aircraft operator is already approved for the conduct of the operations requested
for the same aircraft make and model; and
b. There are no significant differences from previously approved aircraft;
or
c. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-4 for the conduct of RVSM operations;
d. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-XX for the conduct of the navigation operations listed in 1. b
above.
e. The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-XX for the conduct of operations requiring ADS-B listed in
1. c above.
f.
The aircraft operator has the capability of maintaining the aircraft in compliance with
its type design and AC 91-XX for the conduct of the ADS-C operations listed in 1. d
above.
3. Flight Operations:
a. The aircraft operator is already approved for the conduct of the operations requested
for the same aircraft make and model; and
b. There are no significant differences from previously approved aircraft;
or
c. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of RVSM operations in accordance with CAR
§91 and AC 91-4 in domestic and oceanic airspace.
d. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of the navigation operations listed in 1. b
above in accordance with CAR §91 and AC 91-XX.
e. The aircraft operator has been assessed as having the required training and
operational competency for the conduct of operations in airspace requiring ADS-B as
listed in 1. c above in accordance with CAR §91 and AC 91-XX.
f.
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The aircraft operator has been assessed as having the required training and
operational competency for the conduct of operations in airspace requiring ADS-C as
listed in 1. D above in accordance with CAR §91 and AC 91-XX.
CAA 24091/07
Rev 3 : May 2013
Operational Approvals Application
Part G – CAA Approval
Approval Recommendation
Airworthiness
Name:
In assessment
Date:
Continued Airworthiness
Name:
In assessment
Date:
Flight Operations
Name:
In assessment
Date:
Manager Flight Operations Approval
The operations identified in Part G Section 1 are In assessment subject to the conditions and
limitations specified below:
Conditions and Limitations
Manager Flight Operations Approval
Name:
Date:
Approval Completion
1. RVSM inspection report received and satisfactory
(if required).
Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.
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Operational Approvals Application
Appendix A: Additional Aircraft
Aircraft 2
Make:
Model:
Serial No:
Line No:
Variable No:
Registration Mark:
CAA Aircraft ID:
Mode S Code (hex):
C8XXXX
Aircraft History:
New
Used
Previous Registration:
Previous Operator:
State / Country:
Approval Completion
1. RVSM inspection report received and satisfactory
(if required).
Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.
Aircraft 3
Make:
Model:
Serial No:
Line No:
Variable No:
Registration Mark:
CAA Aircraft ID:
Mode S Code (hex):
C8XXXX
Aircraft History:
New
Used
Previous Registration:
Previous Operator:
State / Country:
Approval Completion
1. RVSM inspection report received and satisfactory
(if required).
Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.
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CAA 24091/07
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Operational Approvals Application
Aircraft 4
Make:
Model:
Serial No:
Line No:
Variable No:
Registration Mark:
CAA Aircraft ID:
Mode S Code (hex):
C8XXXX
Aircraft History:
New
Used
Previous Registration:
Previous Operator:
State / Country:
Approval Completion
1. RVSM inspection report received and satisfactory
(if required).
Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.
Aircraft 5
Make:
Model:
Serial No:
Line No:
Variable No:
Registration Mark:
CAA Aircraft ID:
Mode S Code (hex):
C8XXXX
Aircraft History:
New
Used
Previous Registration:
Previous Operator:
State / Country:
Approval Completion
1. RVSM inspection report received and satisfactory
(if required).
Not required
2. Letter(s) of Authorisation issued.
3. Ops Specs revised and approved.
4. For RVSM, PARMO Form F2 submitted.
5. For RVSM, CAA Registration database updated.
6. ACU Operational Approvals database updated.
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CAA 24091/07
Rev 3 : May 2013