NAMCATS 121 Forms Gaz 2967 Part 3
User Manual: NAMCATS 121 -forms gaz 2967-part 3
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Government Gazette 25 April 2003 168 No. 2967 Annexure C REPUBLIC OF NAMIBIA CIVIL AVIATION APPLICATION FOR THE ISSUING OF AN AIR OPERATOR CERTIFICATE APPLICATION FOR THE AMENDMENT OF AN AIR OPERATOR CERTFICATE APPLICATION FOR THE RENEWAL OF AN AIR OPERATOR CERTIFICATE Notes: (i) An application for the issuing of an air operator certificate, or an amendment thereof, must comply with the provisions of CAR 121.05.5. (ii) An application for the renewal of an air operator certificate, must comply with the provisions of CAR 121.06.15. (iii) Section 1 must be completed in all cases. (iv) All other sections must be completed if applicable to the specific application. (v) The original application must be submitted to the Director: Civil Aviation. (vi) Where the required information cannot be furnished in the space provided, the information must be submitted as a separate memorandum and attached hereto. (vii) Please delete if not applicable. Mark the appropriate block Application for the issuing of an air operator certificate Application for the amendment of an air operator certificate Application for the renewal of an air operator certificate 1. PARTICULARS REGARDING THE APPLICANT/HOLDER 1.1 Full name : ........................................................................................................................ 1.2 Trade name, if any : .......................................................................................................... 1.3 Principal place of business: 1.4 Postal address : .......................................................... ................................................... ......................................................... ................................................... ......................................................... ................................................... ......................................................... Postal code ................................ Government Gazette 25 April 2003 No. 2967 169 1.5 Telephone number : .............................. 1.6 Telefax number : ....................... 1.7 Cell phone number : ............................. 1.8 E-mail address: ...................... 1.9 SITA code (if any) : ............................... 1.10 Telex number : .......................... 1.11 Legal status of applicant/holder (individual/close corporation/company/trust/other - specify: ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. 1.12 Registration number in the case of a close corporation/company/trust: ........................... 1.13 Full particulars in respect of the individual/each responsible director/shareholder/partner/ member/office bearer: Name Position Identity Number Nationality .................................... ................................... ................................... .................................... .................................... .................................... .................................... .................................... ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. 1.14 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ Country of permanent residence ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ The applicant/holder declares hereby that the particulars provided in this application are true in every respect. ................................................ Signature ... .................................. Date 2. APPLICATION FOR THE ISSUING OF AN AIR OPERATOR CERTIFICATE 2.1 Description of the type(s) of operation(s) applied for: ....................................................... 2.2 Type(s) of helicopter(s) to be operated: ............................................................................. 2.3 Nationality and registration mark(s) of the helicopter(s) to be operated: .......................... 2.4 Proposed area(s) of operation: ........................................................................................... 2.5 Attached documents: Mark the appropriate block Operations manual Proof of financial capability Maintenance management manual Helicopter maintenance programme Helicopter technical log Maintenance arrangements between applicant and approved aircraft maintenance organisation 170 3. Government Gazette 25 April 2003 No. 2967 APPLICATION FOR THE AMENDMENT OF AN AIR OPERATOR CERTIFICATE 3.1 Certificate number: ................................. 3.2 Expiry date : ................................. 3.3 Particulars of amendment(s) applied for : ........................................................................... 3.4 Attached documents : Mark the appropriate block Amendment to approved operations manual Proof of financial capability in respect of amendment Amended maintenance management manual Amendment to approved helicopter maintenance programme Amendment to approved helicopter technical log Maintenance arrangements between holder and approved aircraft maintenance organisation in respect of amendment 4. APPLICATION FOR THE RENEWAL OF AN AIR OPERATOR CERTIFICATE 4.1 Certificate number : ............................... 4.3 Description of the type(s) of operation(s) applied for: ........................................................ 4.4 Type(s) of helicopter(s) to be operated: ............................................................................. 4.5 Nationality and registration mark(s) of the helicopter(s) to be operated: .......................... 4.6 Proposed area(s) of operation: ........................................................................................... 4.7 4.2 Expiry date : .................................. Supporting documents : Mark the appropriate block Operations manual Proof of financial capability Maintenance management manual Helicopter maintenance programme Helicopter technical log Maintenance arrangements between holder and approved aircraft maintenance organisation No. 2967 Government Gazette 25 April 2003 171 Annexure D REPUBLIC OF NAMIBIA CIVIL AVIATION AIR OPERATOR CERTIFICATE 1. Certificate number: ............................................................................................................ 2. Name of holder : ............................................................................................................... 3. Principal place of business of holder : 5. 4. Postal address of holder: .......................................................... ................................................... .......................................................... ................................................... .......................................................... Postal Code ............................... Type(s) of operation(s) authorised: 6. ....................................................... Type(s) ofaeroplane(s) authorised for operation: ............................ 7. Nationality and registration mark(s) of helicopter(s) authorised for operation: ................ 8. Area(s) of operation: .......................................................................................................... 9. Conditions: ......................................................................................................................... 10. Date issued: ......................................... 11. Expiry date: .............................. 12. Date renewed: ...................................... 13. Expiry date: .............................. 14. I hereby certify that the holder of this certificate has been duly certificated in accordance with Part 127 of the Namibian Civil Aviation Regulations, 2001. Any attachment to this certificate which supplements its contents, forms an integral part hereof. 15. ....................................... Signature ..................................... Date Government Gazette 25 April 2003 172 No. 2967 Annexure E REPUBLIC OF NAMIBIA CIVIL AVIATION APPLICATION FOR THE ISSUING OF A FOREIGN AIR OPERATOR PERMIT APPLICATION FOR THE AMENDMENT OF A FOREIGN AIR OPERATOR PERMIT APPLICATION FOR THE RENEWAL OF A FOREIGN AIR OPERATOR PERMIT Notes: (i) An application for the issuing of a foreign air operator permit, or an amendment thereof, must comply with the provisions of CAR 121.07.2. (ii) An application for the renewal of a foreign air operator permit, must comply with the provisions of CAR 121.07.7. (iii) Section 1 must be completed in all cases. (iv) All other sections must be completed if applicable to the specific application. (v) The original application must be submitted to the Director: Civil Aviation. (vi) Where the required information cannot be furnished in the space provided, the information must be submitted as a separate memorandum and attached thereto. Mark the appropriate block Application for the issuing of a foreign air operator permit Application for the amendment of a foreign air operator permit Application for the renewal of a foreign air operator permit 1. PARTICULARS REGARDING THE APPLICANT/HOLDER 1.1 Full name : ........................................................................................................................ 1.2 Trade name, if any : .......................................................................................................... 1.3 Full business/residential address: 1.4 Postal address : .......................................................... ................................................... ......................................................... ................................................... ......................................................... ................................................... ......................................................... Postal code ................................ Government Gazette 25 April 2003 No. 2967 173 1.5 Telephone number : .............................. 1.6 Telefax number : ....................... 1.7 Cell phone number : ............................. 1.8 E-mail address: ...................... 1.9 SITA code (if any) : ............................... 1.10 Telex number : .......................... 1.11 Legal status of applicant/holder (individual/close corporation/company/trust/other - specify: ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. ............................................................................................................................................. 1.12 Registration number in the case of a close corporation/company/trust: ........................... 1.13 Full particulars in respect of the individual/each responsible director/shareholder/partner/ member/office bearer: Name Position Identity Number Nationality .................................... ................................... ................................... .................................... .................................... .................................... .................................... .................................... ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. 1.14 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ Country of permanent residence ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ ........................................ The applicant/holder declares hereby that the particulars provided in this application are true in every respect. ................................................ Signature ... .................................. Date 2. APPLICATION FOR THE ISSUING OF A FOREIGN AIR OPERATOR PERMIT 2.1 Description of the type(s) of operation(s) applied for: ....................................................... 2.2 Type(s) of helicopter(s) to be operated: ............................................................................. 2.3 Nationality and registration mark(s) of the helicopter(s) to be operated: .......................... 2.4 Proposed area(s) of operation: ........................................................................................... 2.5 Attached documents: Mark the appropriate block Declaration of competency Copy of valid air operator certificate/equivalent authorisation Statement certifying the availability of insurance 174 3. Government Gazette 25 April 2003 No. 2967 APPLICATION FOR THE AMENDMENT OF A AIR OPERATOR CERTIFICATE 3.1 Certificate number: ................................. 3.2 Expiry date : ................................. 3.3 Particulars of amendment(s) applied for : ........................................................................... 3.4 Attached documents : Mark the appropriate block Declaration of competency Copy of air operator certificate/equivalent authorisation Statement certifying the availability of insurance 4. APPLICATION FOR THE RENEWAL OF A FOREIGN AIR OPERATOR PERMIT 4.1 Certificate number : ............................... 4.3 Description of the type(s) of operation(s) applied for: ........................................................ 4.4 Type(s) of helicopter(s) to be operated: ............................................................................. 4.5 Nationality and registration mark(s) of the helicopter(s) to be operated: .......................... 4.6 Proposed area(s) of operation: ........................................................................................... 4.7 4.2 Expiry date : .................................. Supporting documents : Mark the appropriate block Declaration of competency Copy of valid air operator certificate/equivalent authorisation Statement certifying the availability of insurance No. 2967 Government Gazette 25 April 2003 175 Annexure F REPUBLIC OF NAMIBIA CIVIL AVIATION FOREIGN AIR OPERATOR PERMIT 1. Permit number: .................................................................................................................. 2. Name of holder : ............................................................................................................... 3. Principal place of business of holder : 4. Postal address of holder: .......................................................... ................................................... .......................................................... ................................................... .......................................................... Postal Code ............................... 5 Type(s) of operation(s) authorised: 7 Nationality and registration mark(s) of helicopter(s) authorised for operation: ................ 8. Area(s) of operation: .......................................................................................................... 9. Conditions: ......................................................................................................................... 10. Date issued: ......................................... 11. Expiry date: .............................. 12. Date renewed: ...................................... 13. Expiry date: .............................. 14. I hereby certify that the holder of this certificate has been duly certificated in accordance with Part 127 of the Namibian Civil Aviation Regulations, 2001. Any attachment to this certificate which supplements its contents, forms an integral part hereof. 15. 6 ...................................... Signature Type(s) of helicopter(s) authorised for operation: ............................ ..................................... Date __________________
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