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AMC3 SFCL.345 FI(S) - Assessment of competence

Available versions for ERULES-1963177438-17788

ED Decision 2020/004/R found in: Sailplane Rule Book - Part-SAO Part-SFCL CS-22 (Nov 2022)

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AMC3 SFCL.345 FI(S) – Assessment of competence

ED Decision 2020/004/R

APPLICATION AND REPORT FORM FOR THE FI(S) ASSESSMENT OF COMPETENCE

<table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><td colspan="11" width="100%">APPLICATION AND REPORT FORM FOR THE FI(S) ASSESSMENT OF COMPETENCE</td></tr><tr><td colspan="11" width="100%">I hereby apply for the issue of a flight instructor certificate for sailplanes (FI(S)) in accordance with Annex III (Part-SFCL) to Regulation (EU) 2018/1976.</td></tr><tr><td valign="top" width="3%">1 </td><td colspan="10" valign="top" width="96%">Applicant’s personal particulars </td></tr><tr><td colspan="7" valign="top" width="50%">Applicant’s last name(s): </td><td colspan="4" valign="top" width="49%">First name(s): </td></tr><tr><td colspan="5" valign="top" width="33%">Date of birth: </td><td colspan="4" valign="top" width="33%">Telephone: </td><td colspan="2" valign="top" width="33%">Email: </td></tr><tr><td colspan="7" valign="top" width="50%">Address: </td><td colspan="4" valign="top" width="49%">Country: </td></tr><tr><td colspan="7" valign="top" width="50%">Date:</td><td colspan="4" valign="top" width="49%">Signature of the applicant:</td></tr><tr><td valign="top" width="3%">2 </td><td colspan="10" valign="top" width="96%">Licence details </td></tr><tr><td colspan="11" valign="top" width="100%">Licence number (SPL): </td></tr><tr><td colspan="4" valign="top" width="31%">Additional privileges: (tick as applicable)</td><td colspan="4" width="33%"><v:group coordsize="94488,94488" id="Group_x0020_1" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 SUOqXwnz5DrgnHtJTxOsQfEKIT7DmDSUCaxw7Rqn8787ZsmRM9e2VmPeBN4uqYvTtW7jvijg9N/y JsXecLq0q+WD6m8AAAD//wMAUEsDBBQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAX3JlbHMvLnJl bHOkkMFqwzAMhu+DvYPRfXGawxijTi+j0GvpHsDYimMaW0Yy2fr2M4PBMnrbUb/Q94l/f/hMi1qR 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width="31%">Total hours:</td><td colspan="3" width="35%"></td></tr><tr><td colspan="4" rowspan="2" width="31%">Number of launches / take-offs:</td><td colspan="4" width="33%">Aero tow launch:</td><td colspan="3" rowspan="2" width="35%"></td></tr><tr><td colspan="4" width="33%">Winch launch:</td></tr><tr><td valign="top" width="3%">4 </td><td colspan="10" valign="top" width="96%">Pre-entry assessment </td></tr><tr><td colspan="11" valign="top" width="100%">I recommend ..................................... for the FI(S) course.</td></tr><tr><td colspan="7" valign="top" width="50%">Name of ATO/DTO: </td><td colspan="4" valign="top" width="49%">Date of pre-entry assessment: </td></tr><tr><td colspan="11" valign="top" width="100%">Name (capital letters) of HT of the ATO/DTO: </td></tr><tr><td colspan="11" valign="top" width="100%">Name (capital letters), licence number and signature of the FI(S) conducting the flight assessment (if applicable): </td></tr><tr><td valign="top" width="3%">5 </td><td colspan="10" valign="top" width="96%">Declaration by the ATO/DTO</td></tr><tr><td colspan="11" valign="top" width="100%">I certify that .......................................... has satisfactorily completed an approved course of training for the FI(S) certificate in accordance with the relevant syllabus.</td></tr><tr><td colspan="6" valign="top" width="47%">Flying hours during the course: </td><td colspan="5" valign="top" width="52%">Take-offs during the course:</td></tr><tr><td colspan="11" valign="top" width="100%">Sailplanes, powered sailplanes or TMGs used:</td></tr><tr><td colspan="11" valign="top" width="100%">Name(s) of HT: </td></tr><tr><td colspan="11" valign="top" width="100%">Signature: </td></tr><tr><td colspan="11" valign="top" width="100%">Name of ATO/DTO: </td></tr><tr><td colspan="11" valign="top" width="100%">FROM HERE TO BE COMPLETED BY THE EXAMINER</td></tr><tr><td valign="top" width="3%">6 </td><td colspan="10" valign="top" width="96%">Result of the 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different from the competent authority that issued my examiner certificate.</td></tr><tr><td colspan="7" valign="top" width="50%">Examiner’s certificate number:</td><td colspan="4" valign="top" width="50%">Examiner’s SPL number:</td></tr><tr><td colspan="7" valign="top" width="50%">Examiner’s name (capital letters):</td><td colspan="4" valign="top" width="50%">Date and examiner’s signature:</td></tr><tr><td valign="top" width="3%">7 </td><td colspan="10" valign="top" width="96%">Attachments </td></tr><tr><td colspan="11" valign="top" width="100%">Detailed report as per AMC2 SFCL.345 to be attached</td></tr><tr><td colspan="11" valign="top" width="100%">Copy of the FE(S) certificate (in cases where the competent authority of the applicant is different from the competent authority of the examiner)</td></tr><tr height="0"></tr></table>