Competent authority name and logo

(English and any language(s) determined by the competent authority)

EUROPEAN UNION

(English only)

Class 1/2/LAPL

MEDICAL CERTIFICATE

pertaining to a Part-FCL licence

(English and any language(s) determined by the competent authority)

Issued in accordance with Part-MED

This medical certificate complies with ICAO standards, except for the LAPL medical certificate

(English and any language(s) determined by the competent authority)

Requirements

"European Union” to be deleted for non-EU Member States

Size of each page shall be one eighth A4

I             National language(s)/

              Authority that issued or is to issue the pilot licence

III          National language(s):/Certificate number

IV          National language(s):/

              Last and first name of holder:

XIV       National language(s):/Date of birth: (dd/mm/yyyy)

VI          National language(s)/Nationality:

VII         National language(s)/

              Signature of holder:

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XIII        National language(s)/Limitations:

              Code.

              Description :

X            National language(s)/* Date of issue:

              (dd/mm/yyyy)

              Signature of issuing AME/medical assessor /(GMP):

XI          National language(s)/Stamp:

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IX Nat. lang(s)/

Expiry date of this certificate

Class 1 single pilot commercial operations carrying passengers

(dd/mm/yyyy)

Class 1 (dd/mm/yyyy)

Class 2 (dd/mm/yyyy)

LAPL (dd/mm/yyyy)

Nat. lang(s)./Examination

date: (dd/mm/yyyy)

MED.A.020 Decrease in medical fitness

(a) Licence holders shall not exercise the privileges of their licence and related ratings or certificates at any time when they:

(1) are aware of any decrease in their medical fitness that might render them unable to safely exercise those privileges;

(2) take or use any prescribed or non-prescribed medication that is likely to interfere with the safe exercise of the privileges of the applicable licence; or

(3) receive any medical, surgical or other treatment that is likely to interfere with flight safety.

(b) In addition, licence holders shall, without undue delay, seek aero-medical advice when they:

(1) have undergone a surgical operation or invasive procedure;

(2) have commenced the regular use of any medication;

(3) have suffered any significant personal injury involving incapacity to function as a member of the flight crew;

(4) have been suffering from any significant illness involving incapacity to function as a member of the flight crew;

(5) are pregnant;

(6) have been admitted to hospital or medical clinic; or

(7) first require correcting lenses.

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