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AMC1 to Appendix 10 Revalidation and renewal of type ratings, and revalidation and renewal of IRs when combined with the revalidation or renewal of type ratings - EBT practical assessment

Available versions for ERULES-1963177438-19075

ED Decision 2021/002/R found in: Aircrew (1178/2011) Part-FCL Part-MED Part-CC Part-ARA Part-ORA Part-DTO (Aug 2023)

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AMC1 to Appendix 10 Revalidation and renewal of type ratings, and revalidation and renewal of IRs when combined with the revalidation or renewal of type ratings – EBT practical assessment

ED Decision 2021/002/R

APPLICATION AND REPORT FORM — ADMINISTRATIVE PROCEDURES RELATED TO TYPE RATINGS

(a) Minimum information provided in the form for Appendix 10.

<table border="1" cellpadding="0" cellspacing="0" width="614"><tr><td colspan="2" valign="top" width="296">Applicant’s last name(s):</td><td colspan="2" valign="top" width="318">Applicant’s first name(s):</td></tr><tr><td colspan="2" valign="top" width="296">Signature of applicant:</td><td colspan="2" valign="top" width="318">State of licence issue:</td></tr><tr><td colspan="2" valign="top" width="296">Type of licence held:</td><td colspan="2" valign="top" width="318">Licence number:</td></tr><tr><td colspan="2" valign="top" width="296">Type rating:</td><td colspan="2" valign="top" width="318">FSTD (aircraft type):</td></tr><tr><td rowspan="4" valign="top" width="57">EBT module 1</td><td colspan="3" valign="top" width="558">Session 1……..Name of the instructor: __________________________________________________Type and number of licence: _________________________________________________________Location, date and time: ____________________ FSTD ID code:____________________________</td></tr><tr><td colspan="3" valign="top" width="558">Session 2……..Name of the instructor:__________________________________________________Type and number of licence:_________________________________________________________Location, date and time:____________________ FSTD ID code:_____________________________</td></tr><tr><td colspan="3" valign="top" width="558">Session X…...Name of the instructor:___________________________________________________Type and number of licence:_________________________________________________________Location, date and time:____________________ FSTD ID code:_____________________________</td></tr><tr><td colspan="2" valign="top" width="240">Completion of the module:<v:rect fillcolor="window" id="Rectangle_x0020_3" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 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code:_____________________________</td></tr><tr><td colspan="3" valign="top" width="558">Session X…...Name of the instructor:___________________________________________________Type and number of licence:_________________________________________________________Location, date and time:____________________ FSTD ID code:_____________________________</td></tr><tr><td colspan="2" valign="top" width="240">Completion of the module:<v:rect fillcolor="window" id="Rectangle_x0020_11" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 SUOqXwnz5DrgnHtJTxOsQfEKIT7DmDSUCaxw7Rqn8787ZsmRM9e2VmPeBN4uqYvTtW7jvijg9N/y JsXecLq0q+WD6m8AAAD//wMAUEsDBBQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAX3JlbHMvLnJl 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manager)</td></tr><tr><td valign="top" width="57"></td><td colspan="3" valign="top" width="558">(…)</td></tr><tr><td rowspan="4" valign="top" width="57">EBT module X</td><td colspan="3" valign="top" width="558">Session 1……..Name of the instructor: __________________________________________________Type and number of licence: _________________________________________________________Location, date and time: ____________________ FSTD ID code:____________________________</td></tr><tr><td colspan="3" valign="top" width="558">Session 2……..Name of the instructor:__________________________________________________Type and number of licence:_________________________________________________________Location, date and time:____________________ FSTD ID code:_____________________________</td></tr><tr><td colspan="3" valign="top" width="558">Session X…...Name of the instructor:___________________________________________________Type and number of licence:_________________________________________________________Location, date and time:____________________ FSTD ID code:_____________________________</td></tr><tr><td colspan="2" valign="top" width="240">Completion of the module:<v:rect fillcolor="window" id="Rectangle_x0020_12" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 SUOqXwnz5DrgnHtJTxOsQfEKIT7DmDSUCaxw7Rqn8787ZsmRM9e2VmPeBN4uqYvTtW7jvijg9N/y JsXecLq0q+WD6m8AAAD//wMAUEsDBBQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAX3JlbHMvLnJl bHOkkMFqwzAMhu+DvYPRfXGawxijTi+j0GvpHsDYimMaW0Yy2fr2M4PBMnrbUb/Q94l/f/hMi1qR JVI2sOt6UJgd+ZiDgffL8ekFlFSbvV0oo4EbChzGx4f9GRdb25HMsYhqlCwG5lrLq9biZkxWOiqY 22YiTra2kYMu1l1tQD30/bPm3wwYN0x18gb45AdQl1tp5j/sFB2T0FQ7R0nTNEV3j6o9feQzro1i 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colspan="2" valign="top" width="318">Signature</td></tr><tr height="0"></tr></table>

(b) AOC declaration for revalidation and renewal under the EBT programme for the purpose of [AMC1 ARA.GEN.315(a)](#_DxCrossRefBm1199963703) point (d) and for the purpose of point 1(a) of [Appendix 10](#_DxCrossRefBm1199963468).

I confirm all of the following:

<table border="1" cellpadding="0" cellspacing="0"><tr><td valign="top" width="510">The EBT manager holds a current type rating examiner certificate in the type rating filled in in <a href="#_DxCrossRefBm1199963468">Appendix 10</a> (copy to be attached);</td><td valign="top" width="91"><v:rect fillcolor="window" id="Rectangle_x0020_15" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 SUOqXwnz5DrgnHtJTxOsQfEKIT7DmDSUCaxw7Rqn8787ZsmRM9e2VmPeBN4uqYvTtW7jvijg9N/y JsXecLq0q+WD6m8AAAD//wMAUEsDBBQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAX3JlbHMvLnJl bHOkkMFqwzAMhu+DvYPRfXGawxijTi+j0GvpHsDYimMaW0Yy2fr2M4PBMnrbUb/Q94l/f/hMi1qR JVI2sOt6UJgd+ZiDgffL8ekFlFSbvV0oo4EbChzGx4f9GRdb25HMsYhqlCwG5lrLq9biZkxWOiqY 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S8QwEMXvgt8hjODNTVzR2m7TRRRBBA/WP+dsMzZlm0lp0m7dT+940ssMw+O9+b1yu/hezDjGLpCG y5UCgdQE21Gr4f3t8eIWREyGrOkDoYZvjLCtTk9KU9hwoFec69QKDqFYGA0upaGQMjYOvYmrMCCx 9hVGbxKfYyvtaA4c7nu5VupGetMRf3BmwHuHzb6evIbneJzmxsaXxS3uKf/4VMea9lqfny0PGx53 GxAJl/TngN8OzA8Vg+3CRDaKXkOmGD/xzkCwnOdXIHYa1tcZyKqU/ztUPwAAAP//AwBQSwECLQAU AAYACAAAACEAtoM4kv4AAADhAQAAEwAAAAAAAAAAAAAAAAAAAAAAW0NvbnRlbnRfVHlwZXNdLnht bFBLAQItABQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAAAAAAAAAAAAAAC8BAABfcmVscy8ucmVs c1BLAQItABQABgAIAAAAIQAUtzjZIwIAAHIEAAAOAAAAAAAAAAAAAAAAAC4CAABkcnMvZTJvRG9j LnhtbFBLAQItABQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAAAAAAAAAAAAAAH0EAABkcnMvZG93 bnJldi54bWxQSwUGAAAAAAQABADzAAAAigUAAAAA " o:spid="_x0000_s1032" strokecolor="windowText" strokeweight="1pt"></v:rect>YES</td></tr><tr><td valign="top" width="510">The instructor(s) that conducted the training to the applicant has (have) been standardised.</td><td valign="top" width="91"><v:rect fillcolor="window" id="Rectangle_x0020_16" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 SUOqXwnz5DrgnHtJTxOsQfEKIT7DmDSUCaxw7Rqn8787ZsmRM9e2VmPeBN4uqYvTtW7jvijg9N/y JsXecLq0q+WD6m8AAAD//wMAUEsDBBQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAX3JlbHMvLnJl bHOkkMFqwzAMhu+DvYPRfXGawxijTi+j0GvpHsDYimMaW0Yy2fr2M4PBMnrbUb/Q94l/f/hMi1qR JVI2sOt6UJgd+ZiDgffL8ekFlFSbvV0oo4EbChzGx4f9GRdb25HMsYhqlCwG5lrLq9biZkxWOiqY 22YiTra2kYMu1l1tQD30/bPm3wwYN0x18gb45AdQl1tp5j/sFB2T0FQ7R0nTNEV3j6o9feQzro1i OWA14Fm+Q8a1a8+Bvu/d/dMb2JY5uiPbhG/ktn4cqGU/er3pcvwCAAD//wMAUEsDBBQABgAIAAAA IQAUtzjZIwIAAHIEAAAOAAAAZHJzL2Uyb0RvYy54bWysVE2P2jAQvVfqf7B8L0nox1JEWCFW9IJ2 kaDas9dxSCTb444Ngf76jk346HYPVdUcnBl78jzz5k0m9wej2V6hb8GWvBjknCkroWrttuTfN4sP I858ELYSGqwq+VF5fj99/27SubEaQgO6UsgIxPpx50rehODGWeZlo4zwA3DK0mENaEQgF7dZhaIj dKOzYZ5/yTrAyiFI5T3tPpwO+TTh17WS4amuvQpMl5xyC2nFtL7ENZtOxHiLwjWt7NMQ/5CFEa2l Sy9QDyIItsP2DyjTSgQPdRhIMBnUdStVqoGqKfJX1awb4VSqhcjx7kKT/3+w8nG/diskGjrnx57M WMWhRhPflB87JLKOF7LUITBJm8Uo/3r3mTNJR0Xx6WOeyMyuHzv04ZsCw6JRcqReJIrEfukDXUih 55B4lwfdVotW6+Qc/Vwj2wtqG3W7go4zLXygzZIv0hNbRxC/faYt6yib4R0l8xeYG6rlBjdPz1u4 pg2kUt2ako9ug7SNt6iks76oK43ReoHquEKGcBKed3LREhtLKmUlkJRGmqTpCU+01BooeegtzhrA n2/tx3gSAJ1y1pFyS+5/7AQqzuzOzIEYK2jmnEwm4WPQZ7NGMM80MLOIQEfCSsIpuQx4dubhNB00 clLNZimMpOpEWNq1kxE81hw7tzk8C3R9ewNx+QhnxYrxqy6fYqljV1Z6h4SdGtkPYZycWz9FXX8V 018AAAD//wMAUEsDBBQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAZHJzL2Rvd25yZXYueG1sTI9P S8QwEMXvgt8hjODNTVzR2m7TRRRBBA/WP+dsMzZlm0lp0m7dT+940ssMw+O9+b1yu/hezDjGLpCG y5UCgdQE21Gr4f3t8eIWREyGrOkDoYZvjLCtTk9KU9hwoFec69QKDqFYGA0upaGQMjYOvYmrMCCx 9hVGbxKfYyvtaA4c7nu5VupGetMRf3BmwHuHzb6evIbneJzmxsaXxS3uKf/4VMea9lqfny0PGx53 GxAJl/TngN8OzA8Vg+3CRDaKXkOmGD/xzkCwnOdXIHYa1tcZyKqU/ztUPwAAAP//AwBQSwECLQAU AAYACAAAACEAtoM4kv4AAADhAQAAEwAAAAAAAAAAAAAAAAAAAAAAW0NvbnRlbnRfVHlwZXNdLnht bFBLAQItABQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAAAAAAAAAAAAAAC8BAABfcmVscy8ucmVs c1BLAQItABQABgAIAAAAIQAUtzjZIwIAAHIEAAAOAAAAAAAAAAAAAAAAAC4CAABkcnMvZTJvRG9j LnhtbFBLAQItABQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAAAAAAAAAAAAAAH0EAABkcnMvZG93 bnJldi54bWxQSwUGAAAAAAQABADzAAAAigUAAAAA " o:spid="_x0000_s1031" strokecolor="windowText" strokeweight="1pt"></v:rect>YES</td></tr><tr><td valign="top" width="510">The EBT operator has performed a verification of the grading system at least once in the last 3 years.</td><td valign="top" width="91"><v:rect fillcolor="window" id="_x0000_s1030" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 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pg2kUt2ako9ug7SNt6iks76oK43ReoHquEKGcBKed3LREhtLKmUlkJRGmqTpCU+01BooeegtzhrA n2/tx3gSAJ1y1pFyS+5/7AQqzuzOzIEYK2jmnEwm4WPQZ7NGMM80MLOIQEfCSsIpuQx4dubhNB00 clLNZimMpOpEWNq1kxE81hw7tzk8C3R9ewNx+QhnxYrxqy6fYqljV1Z6h4SdGtkPYZycWz9FXX8V 018AAAD//wMAUEsDBBQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAZHJzL2Rvd25yZXYueG1sTI9P S8QwEMXvgt8hjODNTVzR2m7TRRRBBA/WP+dsMzZlm0lp0m7dT+940ssMw+O9+b1yu/hezDjGLpCG y5UCgdQE21Gr4f3t8eIWREyGrOkDoYZvjLCtTk9KU9hwoFec69QKDqFYGA0upaGQMjYOvYmrMCCx 9hVGbxKfYyvtaA4c7nu5VupGetMRf3BmwHuHzb6evIbneJzmxsaXxS3uKf/4VMea9lqfny0PGx53 GxAJl/TngN8OzA8Vg+3CRDaKXkOmGD/xzkCwnOdXIHYa1tcZyKqU/ztUPwAAAP//AwBQSwECLQAU AAYACAAAACEAtoM4kv4AAADhAQAAEwAAAAAAAAAAAAAAAAAAAAAAW0NvbnRlbnRfVHlwZXNdLnht bFBLAQItABQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAAAAAAAAAAAAAAC8BAABfcmVscy8ucmVs c1BLAQItABQABgAIAAAAIQAUtzjZIwIAAHIEAAAOAAAAAAAAAAAAAAAAAC4CAABkcnMvZTJvRG9j LnhtbFBLAQItABQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAAAAAAAAAAAAAAH0EAABkcnMvZG93 bnJldi54bWxQSwUGAAAAAAQABADzAAAAigUAAAAA " strokecolor="windowText" strokeweight="1pt"></v:rect>YES</td></tr><tr><td valign="top" width="510">The integrity of the applicant training data is ensured.</td><td valign="top" width="91"><v:rect fillcolor="window" id="_x0000_s1029" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF 90jcwfIWJU67QAgl6YK0S0CoHGBkTxKLZGx5TGhvj5O2G0SRWNoz/78nu9wcxkFMGNg6quQqL6RA 0s5Y6ir5vt9lD1JwBDIwOMJKHpHlpr69KfdHjyxSmriSfYz+USnWPY7AufNIadK6MEJMx9ApD/oD OlTrorhX2lFEilmcO2RdNtjC5xDF9pCuTyYBB5bi6bQ4syoJ3g9WQ0ymaiLzg5KdCXlKLjvcW893 SUOqXwnz5DrgnHtJTxOsQfEKIT7DmDSUCaxw7Rqn8787ZsmRM9e2VmPeBN4uqYvTtW7jvijg9N/y JsXecLq0q+WD6m8AAAD//wMAUEsDBBQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAX3JlbHMvLnJl bHOkkMFqwzAMhu+DvYPRfXGawxijTi+j0GvpHsDYimMaW0Yy2fr2M4PBMnrbUb/Q94l/f/hMi1qR JVI2sOt6UJgd+ZiDgffL8ekFlFSbvV0oo4EbChzGx4f9GRdb25HMsYhqlCwG5lrLq9biZkxWOiqY 22YiTra2kYMu1l1tQD30/bPm3wwYN0x18gb45AdQl1tp5j/sFB2T0FQ7R0nTNEV3j6o9feQzro1i OWA14Fm+Q8a1a8+Bvu/d/dMb2JY5uiPbhG/ktn4cqGU/er3pcvwCAAD//wMAUEsDBBQABgAIAAAA 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Signature of the training manager or EBT manager\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(c) In order for the EBT manager to delegate their signature in accordance with point 4(c)(2) of [Appendix 10](#_DxCrossRefBm1199963468) to another person to endorse the licence of the applicant, the following should apply:

(1) the person signing the licence should be nominated,

(2) the person signing the licence should hold or have held an instructor certificate,

(3) the approved procedure for delegation of signature should include procedures to prevent the person who received the delegation from signing the licence when the EBT programme applicable to the validity period has not been completed.

(d) The authority may customise the form above by requesting additional information or changing the order of the elements of the form.

AMC1 to Appendix 10 Revalidation and renewal of type ratings,
and revalidation and renewal of IRs when combined with the revalidation or
renewal of type ratings – EBT practical assessment

ED
Decision 2021/002/R

APPLICATION AND REPORT FORM — ADMINISTRATIVE
PROCEDURES RELATED TO TYPE RATINGS

(a)     Minimum information provided in the
form for Appendix 10.

<table border="1" cellpadding="0" cellspacing="0" width="614">
<tr>
<td colspan="2" valign="top" width="296">
Applicant’s
 last name(s):
</td>
<td colspan="2" valign="top" width="318">
Applicant’s
 first name(s):
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="296">
Signature
 of applicant:
</td>
<td colspan="2" valign="top" width="318">
State
 of licence issue:
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="296">
Type
 of licence held:
</td>
<td colspan="2" valign="top" width="318">
Licence
 number:
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="296">
Type
 rating:
</td>
<td colspan="2" valign="top" width="318">
FSTD
 (aircraft type):
</td>
</tr>
<tr>
<td rowspan="4" valign="top" width="57">
EBT module 1
</td>
<td colspan="3" valign="top" width="558">
Session
 1……..Name of the instructor:
 __________________________________________________
Type
 and number of licence: _________________________________________________________
Location,
 date and time: ____________________ FSTD ID code:__________________________
__
</td>
</tr>
<tr>
<td colspan="3" valign="top" width="558">
Session
 2……..Name of the instructor:__________________________________________________
Type
 and number of licence:_________________________________________________________
Location,
 date and time:____________________ FSTD ID code:_____________________________
</td>
</tr>
<tr>
<td colspan="3" valign="top" width="558">
Session
 X…...Name of the
 instructor:___________________________________________________
Type
 and number of
 licence:_________________________________________________________
Location,
 date and time:____________________ FSTD ID
 code:_____________________________
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="240">
Completion
 of the module:
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</td>
<td valign="top" width="318">
_____________________________________________
date
 / signature (EBT manager)
</td>
</tr>
<tr>
<td rowspan="4" valign="top" width="57">
EBT module 2
</td>
<td colspan="3" valign="top" width="558">
Session
 1……..Name of the instructor:
 __________________________________________________
Type
 and number of licence: _________________________________________________________
Location,
 date and time: ____________________ FSTD ID code:__________________________
__
</td>
</tr>
<tr>
<td colspan="3" valign="top" width="558">
Session
 2……..Name of the instructor:__________________________________________________
Type
 and number of licence:_________________________________________________________
Location,
 date and time:____________________ FSTD ID code:_____________________________
</td>
</tr>
<tr>
<td colspan="3" valign="top" width="558">
Session
 X…...Name of the
 instructor:___________________________________________________
Type
 and number of
 licence:_________________________________________________________
Location,
 date and time:____________________ FSTD ID
 code:_____________________________
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="240">
Completion
 of the module:
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</v:rect>
</td>
<td valign="top" width="318">
_____________________________________________
date
 / signature (EBT manager)
</td>
</tr>
<tr>
<td valign="top" width="57">
</td>
<td colspan="3" valign="top" width="558">
(…)
</td>
</tr>
<tr>
<td rowspan="4" valign="top" width="57">
EBT module X
</td>
<td colspan="3" valign="top" width="558">
Session
 1……..Name of the instructor:
 __________________________________________________
Type
 and number of licence: _________________________________________________________
Location,
 date and time: ____________________ FSTD ID code:__________________________
__
</td>
</tr>
<tr>
<td colspan="3" valign="top" width="558">
Session
 2……..Name of the instructor:__________________________________________________
Type
 and number of licence:_________________________________________________________
Location,
 date and time:____________________ FSTD ID code:_____________________________
</td>
</tr>
<tr>
<td colspan="3" valign="top" width="558">
Session
 X…...Name of the
 instructor:___________________________________________________
Type
 and number of licence:_________________________________________________________
Location,
 date and time:____________________ FSTD ID
 code:_____________________________
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="240">
Completion
 of the module:
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</v:rect>
</td>
<td valign="top" width="318">
_____________________________________________
date
 / signature (EBT manager)
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="296">
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</v:rect>Completion of
 the operator’s EBT programme from____(date) to ____(date)
</td>
<td colspan="2" valign="top" width="318">
____________________________________________ 
 date / signature (EBT manager)
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="296">
Name(s)
 in capital letters:
Type
 and number of licence:
Examiner
 certificate number:
</td>
<td colspan="2" valign="top" width="318">
Signature
 of examiner (EBT manager) _____________________________________________
Date
 of applicant’s licence endorsement: ___________
</td>
</tr>
<tr>
<td colspan="4" valign="top" width="614">
Delegation
 of signature for licence endorsement (instructor)
</td>
</tr>
<tr>
<td colspan="2" valign="top" width="296">
Name:
Position
 in the operator:
Date:
</td>
<td colspan="2" valign="top" width="318">
Signature
</td>
</tr>
<tr height="0">
</tr>
</table>

(b)     AOC
declaration for revalidation and renewal under the EBT programme for the
purpose of [AMC1 ARA.GEN.315(a)](#_DxCrossRefBm894735847)
point (d) and for the purpose of point 1(a) of [Appendix 10](#_DxCrossRefBm894735611).

I confirm all of the following:

<table border="1" cellpadding="0" cellspacing="0">
<tr>
<td valign="top" width="510">
The
 EBT manager holds a current type rating examiner certificate in the type
 rating filled in in <a href="#_DxCrossRefBm894735611">Appendix 10</a>
 (copy to be attached);
</td>
<td valign="top" width="91">
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018AAAD//wMAUEsDBBQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAZHJzL2Rvd25yZXYueG1sTI9P
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9hVGbxKfYyvtaA4c7nu5VupGetMRf3BmwHuHzb6evIbneJzmxsaXxS3uKf/4VMea9lqfny0PGx53
GxAJl/TngN8OzA8Vg+3CRDaKXkOmGD/xzkCwnOdXIHYa1tcZyKqU/ztUPwAAAP//AwBQSwECLQAU
AAYACAAAACEAtoM4kv4AAADhAQAAEwAAAAAAAAAAAAAAAAAAAAAAW0NvbnRlbnRfVHlwZXNdLnht
bFBLAQItABQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAAAAAAAAAAAAAAC8BAABfcmVscy8ucmVs
c1BLAQItABQABgAIAAAAIQAUtzjZIwIAAHIEAAAOAAAAAAAAAAAAAAAAAC4CAABkcnMvZTJvRG9j
LnhtbFBLAQItABQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAAAAAAAAAAAAAAH0EAABkcnMvZG93
bnJldi54bWxQSwUGAAAAAAQABADzAAAAigUAAAAA
" o:spid="_x0000_s1032" strokecolor="windowText" strokeweight="1pt">
</v:rect>YES
</td>
</tr>
<tr>
<td valign="top" width="510">
The
 instructor(s) that conducted the training to the applicant has (have) been
 standardised.
</td>
<td valign="top" width="91">
<v:rect fillcolor="window" id="Rectangle_x0020_16" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF
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018AAAD//wMAUEsDBBQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAZHJzL2Rvd25yZXYueG1sTI9P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" o:spid="_x0000_s1031" strokecolor="windowText" strokeweight="1pt">
</v:rect>YES
</td>
</tr>
<tr>
<td valign="top" width="510">
The
 EBT operator has performed a verification of the grading system at least
 once in the last 3 years.
</td>
<td valign="top" width="91">
<v:rect fillcolor="window" id="_x0000_s1030" o:gfxdata="UEsDBBQABgAIAAAAIQC2gziS/gAAAOEBAAATAAAAW0NvbnRlbnRfVHlwZXNdLnhtbJSRQU7DMBBF
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018AAAD//wMAUEsDBBQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAZHJzL2Rvd25yZXYueG1sTI9P
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9hVGbxKfYyvtaA4c7nu5VupGetMRf3BmwHuHzb6evIbneJzmxsaXxS3uKf/4VMea9lqfny0PGx53
GxAJl/TngN8OzA8Vg+3CRDaKXkOmGD/xzkCwnOdXIHYa1tcZyKqU/ztUPwAAAP//AwBQSwECLQAU
AAYACAAAACEAtoM4kv4AAADhAQAAEwAAAAAAAAAAAAAAAAAAAAAAW0NvbnRlbnRfVHlwZXNdLnht
bFBLAQItABQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAAAAAAAAAAAAAAC8BAABfcmVscy8ucmVs
c1BLAQItABQABgAIAAAAIQAUtzjZIwIAAHIEAAAOAAAAAAAAAAAAAAAAAC4CAABkcnMvZTJvRG9j
LnhtbFBLAQItABQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAAAAAAAAAAAAAAH0EAABkcnMvZG93
bnJldi54bWxQSwUGAAAAAAQABADzAAAAigUAAAAA
" strokecolor="windowText" strokeweight="1pt">
</v:rect>YES
</td>
</tr>
<tr>
<td valign="top" width="510">
The integrity
 of the applicant training data is ensured.
</td>
<td valign="top" width="91">
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55B4lwfdVotW6+Qc/Vwj2wtqG3W7go4zLXygzZIv0hNbRxC/faYt6yib4R0l8xeYG6rlBjdPz1u4
pg2kUt2ako9ug7SNt6iks76oK43ReoHquEKGcBKed3LREhtLKmUlkJRGmqTpCU+01BooeegtzhrA
n2/tx3gSAJ1y1pFyS+5/7AQqzuzOzIEYK2jmnEwm4WPQZ7NGMM80MLOIQEfCSsIpuQx4dubhNB00
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AAYACAAAACEAtoM4kv4AAADhAQAAEwAAAAAAAAAAAAAAAAAAAAAAW0NvbnRlbnRfVHlwZXNdLnht
bFBLAQItABQABgAIAAAAIQA4/SH/1gAAAJQBAAALAAAAAAAAAAAAAAAAAC8BAABfcmVscy8ucmVs
c1BLAQItABQABgAIAAAAIQAUtzjZIwIAAHIEAAAOAAAAAAAAAAAAAAAAAC4CAABkcnMvZTJvRG9j
LnhtbFBLAQItABQABgAIAAAAIQByU/+o4AAAAAsBAAAPAAAAAAAAAAAAAAAAAH0EAABkcnMvZG93
bnJldi54bWxQSwUGAAAAAAQABADzAAAAigUAAAAA
" strokecolor="windowText" strokeweight="1pt">
</v:rect>YES
</td>
</tr>
</table>

Signature of the training manager or EBT
manager\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(c)      In order for
the EBT manager to delegate their signature in accordance with point 4(c)(2)
of [Appendix 10](#_DxCrossRefBm894735611) to another person to
endorse the licence of the applicant, the following should apply:

(1)     the person
signing the licence should be nominated,

(2)     the person
signing the licence should hold or have held an instructor certificate,

(3)     the approved
procedure for delegation of signature should include procedures to prevent the
person who received the delegation from signing the licence when the EBT programme
applicable to the validity period has not been completed.

(d)     The authority
may customise the form above by requesting additional information or changing the
order of the elements of the form.

##### AMC1 to Appendix 10 Revalidation and renewal of type ratings, and revalidation and renewal of IRs when combined with the revalidation or renewal of type ratings – EBT practical assessment

*ED
Decision 2021/002/R*

**APPLICATION
AND REPORT FORM — ADMINISTRATIVE PROCEDURES RELATED TO TYPE RATINGS**

(a) Minimum information provided in the
form for Appendix 10.

<table cellpadding="7" cellspacing="0">
<col/>
<col/>
<col/>
<col/>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Applicant’s
			last name(s):
</td>
<td bgcolor="#d9d9d9" colspan="2">
Applicant’s
			first name(s):
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Signature
			of applicant:
</td>
<td bgcolor="#d9d9d9" colspan="2">
State
			of licence issue:
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Type
			of licence held:
</td>
<td bgcolor="#d9d9d9" colspan="2">
Licence
			number:
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Type
			rating:
</td>
<td bgcolor="#d9d9d9" colspan="2">
FSTD
			(aircraft type):
</td>
</tr>
<tr valign="top">
<td bgcolor="#808080" rowspan="4">
EBT
			module 1
</td>
<td bgcolor="#d9d9d9" colspan="3">
Session
			1……..Name of the instructor:
			__________________________________________________

Type
			and number of licence:
			_________________________________________________________
Location,
			date and time: ____________________ FSTD ID
			code:__________________________ 
__
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="3">
Session
			2……..Name of the
			instructor:__________________________________________________

Type
			and number of
			licence:_________________________________________________________
Location,
			date and time:____________________ FSTD ID
			code:_____________________________
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="3">
Session
			X…...Name of the
			instructor:___________________________________________________

Type
			and number of
			licence:_________________________________________________________
Location,
			date and time:____________________ FSTD ID
			code:_____________________________
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Completion
			of the module:
<img align="left" alt="Shape24" hspace="13" name="Shape24" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
 

</td>
<td bgcolor="#d9d9d9">
_____________________________________________
date
			/ signature (EBT manager)
</td>
</tr>
<tr valign="top">
<td bgcolor="#808080" rowspan="4">
EBT
			module 2
</td>
<td bgcolor="#d9d9d9" colspan="3">
Session
			1……..Name of the instructor:
			__________________________________________________

Type
			and number of licence:
			_________________________________________________________
Location,
			date and time: ____________________ FSTD ID
			code:__________________________ 
__
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="3">
Session
			2……..Name of the
			instructor:__________________________________________________

Type
			and number of
			licence:_________________________________________________________
Location,
			date and time:____________________ FSTD ID
			code:_____________________________
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="3">
Session
			X…...Name of the
			instructor:___________________________________________________

Type
			and number of
			licence:_________________________________________________________
Location,
			date and time:____________________ FSTD ID
			code:_____________________________
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Completion
			of the module:
<img align="left" alt="Shape25" hspace="13" name="Shape25" src="source-marked.part-0014_html_aa830eb.gif" vspace="1"/>
 

</td>
<td bgcolor="#d9d9d9">
_____________________________________________
date
			/ signature (EBT manager)
</td>
</tr>
<tr valign="top">
<td bgcolor="#808080">
 

</td>
<td bgcolor="#d9d9d9" colspan="3">
(…)
</td>
</tr>
<tr valign="top">
<td bgcolor="#808080" rowspan="4">
EBT
			module X
</td>
<td bgcolor="#d9d9d9" colspan="3">
Session
			1……..Name of the instructor:
			__________________________________________________

Type
			and number of licence:
			_________________________________________________________
Location,
			date and time: ____________________ FSTD ID
			code:__________________________ 
__
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="3">
Session
			2……..Name of the
			instructor:__________________________________________________

Type
			and number of
			licence:_________________________________________________________
Location,
			date and time:____________________ FSTD ID
			code:_____________________________
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="3">
Session
			X…...Name of the
			instructor:___________________________________________________

Type
			and number of
			licence:_________________________________________________________
Location,
			date and time:____________________ FSTD ID
			code:_____________________________
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Completion
			of the module:
<img align="left" alt="Shape26" hspace="13" name="Shape26" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
 

</td>
<td bgcolor="#d9d9d9">
_____________________________________________
date
			/ signature (EBT manager)
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
C<img align="left" alt="Shape27" hspace="13" name="Shape27" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
ompletion
			of the operator’s EBT programme from____(date) to ____(date)
</td>
<td bgcolor="#d9d9d9" colspan="2">
____________________________________________ 
date
			/ signature (EBT manager)
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Name(s)
			in capital letters:

Type
			and number of licence:
Examiner
			certificate number:
</td>
<td bgcolor="#d9d9d9" colspan="2">
Signature
			of examiner (EBT manager)
			_____________________________________________
Date
			of applicant’s licence endorsement: ___________
</td>
</tr>
<tr>
<td bgcolor="#d9d9d9" colspan="4" valign="top">
Delegation
			of signature for licence endorsement (instructor)
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9" colspan="2">
Name:

Position
			in the operator:
Date:
</td>
<td bgcolor="#d9d9d9" colspan="2">
Signature
</td>
</tr>
</table>

(b) AOC declaration for revalidation and renewal under the EBT
programme for the purpose of [AMC1 ARA.GEN.315(a)](#_DxCrossRefBm1743303511)
point (d) and for the purpose of point 1(a) of [Appendix 10](#_DxCrossRefBm1743303264).

I confirm all of the following:

<table cellpadding="7" cellspacing="0">
<col/>
<col/>
<tr valign="top">
<td bgcolor="#d9d9d9">
The
			EBT manager holds a current type rating examiner certificate in
			the type rating filled in in <a href="#_DxCrossRefBm1743303264">Appendix 10</a>
			(copy to be attached);
</td>
<td bgcolor="#d9d9d9">
Y<img align="left" alt="Shape28" hspace="13" name="Shape28" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
ES
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9">
The
			instructor(s) that conducted the training to the applicant has
			(have) been standardised.
</td>
<td bgcolor="#d9d9d9">
Y<img align="left" alt="Shape29" hspace="13" name="Shape29" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
ES
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9">
The
			EBT operator has performed a verification of the grading system at
			least once in the last 3 years.
</td>
<td bgcolor="#d9d9d9">
Y<img align="left" alt="Shape30" hspace="13" name="Shape30" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
ES
</td>
</tr>
<tr valign="top">
<td bgcolor="#d9d9d9">
The
			integrity of the applicant training data is ensured.
</td>
<td bgcolor="#d9d9d9">
Y<img align="left" alt="Shape31" hspace="13" name="Shape31" src="source-marked.part-0014_html_e91054ce.gif" vspace="1"/>
ES
</td>
</tr>
</table>

Signature of the training manager or EBT
manager\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(c) In order for the EBT manager to delegate their signature in
accordance with point 4(c)(2) of [Appendix 10](#_DxCrossRefBm1743303264)
to another person to endorse the licence of the applicant, the
following should apply:

(1) the person signing the licence should be nominated,

(2) the person signing the licence should hold or have held an
instructor certificate,

(3) the approved procedure for delegation of signature should include
procedures to prevent the person who received the delegation from
signing the licence when the EBT programme applicable to the validity
period has not been completed.

(d) The authority may customise the form above by requesting
additional information or changing the order of the elements of the
form.

Compare / EASA/ Incorporated Amendments/ Compare & Highlight Differences

AMC1 to Appendix 10 Revalidation and renewal of type ratings, and revalidation and renewal of IRs when combined with the revalidation or renewal of type ratings - EBT practical assessment

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