AMC1 ATCO.AR.D.003(a)(1) Change of competent authority
ED
Decision 2023/011/R
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LICENCE
VERIFICATION FORM This form should be filled in and signed by the
issuing competent authority of the licence being transferred. |
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ITEM |
DESCRIPTION |
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1 |
State of licence(s) issue |
Country |
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2 |
Title of licence |
ATCO or Student ATCO |
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3 |
Licence issue date |
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4 |
Full name (Last and first names) |
LAST NAME 1, LAST NAME 2, etc. First name 1, First name 2, etc. |
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5 |
Date of birth (dd/mm/yyyy) |
xx/xx/xxxx |
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6 |
Address (if indicated on the licence) |
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7 |
Contact details: email: phone number: |
e.g. +(country code) xxxxxxxx |
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8 |
Nationality |
Country |
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9 |
Transferring competent authority |
Country and authority |
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10 |
Valid and non-expired unit, instructor and assessor
endorsements held |
Endorsements |
Valid until (dd/mm/yyyy) |
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e.g. EDDK APS/SRA |
xx/xx/xxxx |
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e.g. OJTI STDI Assessor |
xx/xx/xxxx |
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11 |
Ratings and rating endorsements held |
Ratings and rating endorsements |
Date of first issue (dd/mm/yyyy) |
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e.g. ADI ACS RAD PAR |
xx/xx/xxxx |
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12 |
Remarks, i.e. licence endorsements relating to
language proficiency level and validity (English, others) |
Language proficiency endorsements |
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Language |
Level |
Validity (dd/mm/yyyy) |
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13 |
Past or pending enforcement action* |
Yes o
No o (If yes, please provide
details on a separate page.) |
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* Item 13: Specify whether there is an ongoing
investigation into the medical certificate and licence, or its suspension or
revocation.
[applicable from 4 August 2024 - ED Decision 2023/011/R]
For Air Traffic Controller (ATCO) license transfers, a verification form must be completed by the issuing authority. This form confirms license details, endorsements, ratings, language proficiency, and any past or pending enforcement actions. This ensures accurate record transfer between competent authorities for ATCO licensing and certification.
* Summary by Aviation.Bot - Always consult the original document for the most accurate information.
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