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Appendix VII to ANNEX VI (Part-ARA) – Certificate for Aeromedical Examiners (AMEs)

Regulation (EU) 2024/2076



CERTIFICATE FOR AERO-MEDICAL EXAMINERS (AMEs)


European Union ([36])

Competent Authority


AERO-MEDICAL EXAMINER CERTIFICATE


CERTIFICATE NUMBER/REFERENCE:



Pursuant to Commission Regulation (EU) No 1178/2011 and Regulation (EU) 2015/340 ([37]) and subject to the conditions specified below, the [competent authority] hereby certifies


[NAME OF THE AERO-MEDICAL EXAMINER]


[PRACTICE ADDRESS(ES) OF THE AERO-MEDICAL EXAMINER]


as aero-medical examiner



CONDITIONS:


1. This certificate is limited to the privileges specified in the attachment to this AME certificate;

2. This certificate requires compliance with the implementing rules and procedures specified in Part-MED/Part ATCO.MED ([38]).

3. This certificate shall remain valid from [dd/mm/yyyy] until [dd/mm/yyyy ([39])] subject to compliance with the requirements of Part-MED/Part ATCO.MED (2) unless it has been surrendered, superseded, suspended or revoked.



Date of issue: dd/mm/yyyy Signature: [Competent Authority]








EASA Form 148 Issue 2


AERO-MEDICAL EXAMINER CERTIFICATE




Attachment ([40]) to AME certificate number:



PRIVILEGES AND SCOPE



[Name and academic title of the aero-medical examiner] has obtained the privilege(s) to undertake aero-medical examinations and assessments for the issuance of medical certificates and medical reports as stated in the table below and to issue these medical certificates and medical reports for:



Class 1 revalidation/renewal

[valid until]/[Not Applicable]

Class 2/LAPL/Cabin crew Initial/revalidation/renewal

[valid until]

Class 3 ([41]) revalidation/renewal

[valid until]/[Not Applicable]





Date of issue: dd/mm/yyyy Signature: [Competent Authority]


[36] 'European Union' to be deleted for non-EU Member States

[37] Reference to Regulation (EU) No 1178/2011 or Regulation (EU) 2015/340 as well as Part-MED and Part ATCO.MED shall be modified as per the certificate’s scope.

[38] Reference to Regulation (EU) No 1178/2011 or Regulation (EU) 2015/340 as well as Part-MED and Part ATCO.MED shall be modified as per the certificate’s scope.

[39] Expiry date format: day/month/year.

[40] This attachment may be issued as part of the AME certificate or as a separate document.

[41] Class 3 shall be added only for the AMEs approved to perform class 3 aero-medical examinations.