AMC1 ATCO.AR.F.005
Medical certificate
ED Decision 2015/010/R
STANDARD MEDICAL CERTIFICATE FORMAT
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Competent authority’s name and logo (English and any language(s) determined by the competent authority) EUROPEAN UNION (English only) Class 3 MEDICAL CERTIFICATE Pertaining to a Part ATCO licence (English and any language(s) determined by the competent authority) Issued in accordance with Part ATCO.MED This medical certificate complies with the ICAO Standards (English and any language(s) determined by the competent authority) |
Requirements: ‘European Union’ to be deleted for non-EU Member States. The size of each page should be one eighth A4. English and any language(s) determined by the competent authority. |
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I Authority that issued or is to issue the ATCO licence: III Certificate number: IV Last and first name of holder: XIV Date of birth: (dd/mm/yyyy) VI Nationality: VII Signature of holder: |
XIII Limitations: Code: Description: X Date of issue*: Signature of issuing AME/medical assessor: XI Stamp: |
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IX Expiry date of this certificate: |
dd/mm/yyyy |
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Examination date: (dd/mm/yyyy) |
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* Date of issue is the date when the certificate is issued and signed.
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