AMC1 ATCO.AR.F.005 Medical certificate

• ED Decision 2015/010/R found in: Air Traffic Controllers Licensing and Certification (2015/340) Part-ATCO (Jun 2024)

AMC1 ATCO.AR.F.005 Medical certificate ED Decision 2015/010/R STANDARD MEDICAL CERTIFICATE FORMAT <table border="1" cellpadding="0" cellspacing="0" width="604"> <tr> <td valign="top" width="302"> <p>Competent authority’s name and logo</p> <p>(English and any language(s) determined by the competent authority)</p> <p>EUROPEAN UNION</p> <p>(English only)</p> <p>Class 3</p> <p>MEDICAL CERTIFICATE</p> <p>Pertaining to a Part ATCO licence</p> <p>(English and any language(s) determined by the competent authority)</p> <p>Issued in accordance with Part ATCO.MED</p> <p>This medical certificate complies with the ICAO Standards</p> <p>(English and any language(s) determined by the competent authority)</p> </td> <td valign="top" width="302"> <p>Requirements:</p> <p>‘European Union’ to be deleted for non-EU Member States.</p> <p>The size of each page should be one eighth A4.</p> <p>English and any language(s) determined by the competent authority. </p> </td> </tr> </table> <table align="left" border="1" cellpadding="0" cellspacing="0" width="604"> <tr> <td valign="top" width="302"> <p>I            Authority that issued or is to issue the ATCO licence:</p> <p>III          Certificate number:</p> <p>IV         Last and first name of holder:</p> <p>XIV       Date of birth: (dd/mm/yyyy)</p> <p>VI         Nationality:</p> <p>VII        Signature of holder:</p> </td> <td valign="top" width="302"> <p>XIII       Limitations:</p> <p>             Code:</p> <p>             Description:</p> <p>X          Date of issue*:</p> <p>             Signature of issuing AME/medical assessor:</p> <p>XI         Stamp:</p> </td> </tr> <tr> <td width="302"> <p>2</p> </td> <td width="302"> <p>3</p> </td> </tr> </table> <table border="1" cellpadding="0" cellspacing="0"> <tr> <td colspan="2" valign="top" width="196"> <p>IX    Expiry date of this certificate:</p> </td> <td valign="top" width="104"> <p>dd/mm/yyyy</p> </td> </tr> <tr> <td colspan="3" valign="top" width="300"> <p>Examination date: (dd/mm/yyyy)</p> </td> </tr> <tr> <td valign="top" width="143"> </td> <td colspan="2" valign="top" width="158"> </td> </tr> <tr> <td valign="top" width="143"> </td> <td colspan="2" valign="top" width="158"> </td> </tr> <tr> <td valign="top" width="143"> </td> <td colspan="2" valign="top" width="158"> </td> </tr> <tr> <td colspan="3" width="300"> </td> </tr> <tr> <td colspan="3" width="300"> <p>4</p> </td> </tr> <tr height="0"> </tr> </table> \*          Date of issue is the date when the certificate is issued and signed.