APPLICATION FOR CASA AUTHORISATION ON THE BASIS OF OVERSEAS QUALIFICATIONS
PERSONAL DETAILS
SURNAME GIVEN NAMES TITLE
RESIDENTIAL ADDRESS
IN AUSTRALIA:

Postcode:

Phone: Fax:

How long will you be staying in Australia?
DETAILS OF OVERSEAS LICENCE
Country of Issue:

Licence Type: Number

Date of Expiry of Licence: / / Date of Expiry of Medical: / /

Current Ratings:

Instrument

  

Instructor

  

Agricultural

  

Other

    
Do you hold a separate Flight Radio Telephone Operators Licence? Yes q No q

Number: Date of Issue: / /

Are there any restrictions (medical or operational) on your licence(s)?
CASA AUTHORISATION REQUIRED
 

1. Certificate of Validation:

 		               
 

2. Special Pilot Licence:

 		               
 

3. Australian Flight Crew Licence:

 		               
 

Aeroplane

 		 

Helicopter

  

Other

        
 

Private

 		 

Commercial

  

Air Transport

  

Flight Engineer

    
 

4. Ratings:

Instrument

 		 

Instructor

  

Agricultural

  

Other

    
 
AERONAUTICAL EXPERIENCE

AIRCRAFT

TOTAL DAY

TOTAL NIGHT

TOTAL
CATEGORY

Dual

Co-pilot

ICUS *

In Command

Dual

Co-pilot

ICUS *

In command

  
Aeroplane                  
Helicopter                  
                   
ICUS = In command under supervision ………. Total Cross country flight time: ……. Total …….… in command (PIC)

Instrument flight time: . … .. Total ………. cross country Instrument ground time: ………. Total

Date of most recent flying: …./…/… (Dual/Co-pilot/ICUS/PIC) Date of most recent flight test or proficiency review: / /

AIRCRAFT ENDORSEMENTS
LIST THE AIRCRAFT FOR WHICH YOU ARE ENDORSED AND WISH TO FLY IN AUSTRALIA.
(PLEASE NOMINATE WHETHER THE ENDORSEMENT IS FOR COMMAND OR CO-PILOT DUTIES.)

1. SINGLE ENGINE AEROPLANES:

2. MULTI ENGINE AEROPLANES:

3. SPECIAL AEROPLANE DESIGN FEATURES
    CONSTANT SPEED PROPELLER   SKI LANDING GEAR   PRESSURISATION SYSTEM
 
    TAIL WHEEL UNDERCARRIAGE   FLOAT ALIGHT GEAR    
 
    RETRACTABLE UNDERCARRIAGE   FLOATING HULL    

4. HELICOPTERS:

5. SPECIAL HELICOPTER ENDORSEMENTS:
    WINCHING   RAPPELLING    
 
    SLING   FLOAT ALIGHTING GEAR    
 
    SKI LANDING GEAR        

6. OTHER AIRCRAFT
DECLARATION BY APPLICANT
I hereby declare that the particulars set out in this application are true in every respect.

/ /

Signature of Applicant Date
DECLARATION BY INDUSTRY DELEGATE (optional)
I confirm that the above mentioned person satisfies the aeronautical experience requirements of the Civil Aviation Regulations ………. for the grant of a ………………………… Pilot Licence

/ /

Signature of Delegate Printed Name ARN Date
CASA OFFICE USE ONLY
Fee collected: $ ARN Allocated:

Overseas authorisation sighted (copy attached): q CASA authorisation issued: CV q FCL q SPECPL q

(Checklist attached)

Endorsements:

Ratings: Approving officer:

LARP update by: Office: Date: / /