NAMCATS 121 forms Gaz 2967 part 3

168 Government Gazette 25 April 2003 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 ................................

No. 2967 169

Government Gazette 25 April 2003

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:

1.14 The applicant/holder declares hereby that the particulars provided in this application are

true in every respect.

................................................ ... ..................................

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

Name

....................................

...................................

....................................

Position

........................

Identity Number

..............................

Nationality

........................

Country of permanent

residence

........................................

Signature Date

170 Government Gazette 25 April 2003 No. 2967

3. 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 : ............................... 4.2 Expiry date : ..................................

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 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 171

Government Gazette 25 April 2003

Annexure D

REPUBLIC OF NAMIBIA

CIVIL AVIATION

AIR OPERATOR CERTIFICATE

1. Certificate 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: 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.

15. Any attachment to this certificate which supplements its contents, forms an integral part

hereof.

....................................... .....................................

Signature Date

172 Government Gazette 25 April 2003 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 ................................

No. 2967 173

Government Gazette 25 April 2003

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:

1.14 The applicant/holder declares hereby that the particulars provided in this application are

true in every respect.

................................................ ... ..................................

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

Name

....................................

...................................

....................................

Position

........................

Identity Number

..............................

Nationality

........................

Country of permanent

residence

........................................

Signature Date

174 Government Gazette 25 April 2003 No. 2967

3. 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 : ............................... 4.2 Expiry date : ..................................

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 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 175

Government Gazette 25 April 2003

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: 6 Type(s) of helicopter(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.

15. Any attachment to this certificate which supplements its contents, forms an integral part

hereof.

...................................... .....................................

__________________

Signature Date

NAMCATS 121 Forms Gaz 2967 Part 3

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