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AMC1 ATCO.AR.D.003(a)(1) Change of competent authority
Available versions for ERULES-1963177438-21847
ED Decision 2023/011/R
found in: Air Traffic Controllers Licensing and Certification (2015/340) Part-ATCO (Jun 2024)
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Air Traffic Contro... (Jun 2024)
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AMC1 ATCO.AR.D.003(a)(1) Change of competent authority ED Decision 2023/011/R <table border="1" cellpadding="0" cellspacing="0" width="614"> <tr> <td colspan="6" width="614"> <p align="center"><b>LICENCE VERIFICATION FORM</b></p> <p>This form should be filled in and signed by the issuing competent authority of the licence being transferred.</p> </td> </tr> <tr> <td valign="top" width="47"> <p>ITEM</p> </td> <td valign="top" width="289"> <p>DESCRIPTION</p> </td> <td colspan="4" valign="top" width="279"> </td> </tr> <tr> <td valign="top" width="47"> <p>1</p> </td> <td valign="top" width="289"> <p>State of licence(s) issue </p> </td> <td colspan="4" valign="top" width="279"> <p><i>Country </i></p> </td> </tr> <tr> <td valign="top" width="47"> <p>2</p> </td> <td valign="top" width="289"> <p>Title of licence </p> </td> <td colspan="4" valign="top" width="279"> <p><i>ATCO or Student ATCO</i></p> </td> </tr> <tr> <td valign="top" width="47"> <p>3</p> </td> <td valign="top" width="289"> <p>Licence issue date </p> </td> <td colspan="4" valign="top" width="279"> <p></p> </td> </tr> <tr> <td valign="top" width="47"> <p>4</p> </td> <td valign="top" width="289"> <p>Full name </p> <p>(Last and first names)</p> </td> <td colspan="4" valign="top" width="279"> <p><i>LAST NAME 1, LAST NAME 2, etc. </i></p> <p><i>First name 1, First name 2, etc. </i></p> </td> </tr> <tr> <td valign="top" width="47"> <p>5</p> </td> <td valign="top" width="289"> <p>Date of birth (dd/mm/yyyy) </p> </td> <td colspan="4" valign="top" width="279"> <p><i>xx/xx/xxxx </i></p> </td> </tr> <tr> <td valign="top" width="47"> <p>6</p> </td> <td valign="top" width="289"> <p>Address </p> <p>(if indicated on the licence) </p> </td> <td colspan="4" valign="top" width="279"> <p></p> </td> </tr> <tr> <td valign="top" width="47"> <p>7</p> </td> <td valign="top" width="289"> <p>Contact details: </p> <p>email:</p> <p>phone number: </p> </td> <td colspan="4" valign="top" width="279"> <p><i>e.g. </i></p> <p><i>example@example.eu </i></p> <p><i>+(country code) xxxxxxxx</i></p> <p></p> </td> </tr> <tr> <td valign="top" width="47"> <p>8</p> </td> <td valign="top" width="289"> <p>Nationality </p> </td> <td colspan="4" valign="top" width="279"> <p><i>Country </i></p> </td> </tr> <tr> <td valign="top" width="47"> <p>9</p> </td> <td valign="top" width="289"> <p>Transferring competent authority </p> </td> <td colspan="4" valign="top" width="279"> <p><i>Country and authority </i></p> </td> </tr> <tr> <td rowspan="3" valign="top" width="47"> <p>10</p> </td> <td rowspan="3" valign="top" width="289"> <p>Valid and non-expired unit, <b>instructor and assessor endorsements</b> held </p> </td> <td colspan="2" valign="top" width="135"> <p><b>Endorsements</b></p> </td> <td colspan="2" valign="top" width="143"> <p><b>Valid until (dd/mm/yyyy) </b></p> </td> </tr> <tr> <td colspan="2" valign="top" width="135"> <p><i>e.g. </i></p> <p><i>EDDK APS/SRA</i></p> <p></p> </td> <td colspan="2" valign="top" width="143"> <p><i>xx/xx/xxxx </i></p> </td> </tr> <tr> <td colspan="2" valign="top" width="135"> <p><i>e.g. </i></p> <p><i>OJTI</i></p> <p><i>STDI</i></p> <p><i>Assessor</i></p> <p></p> </td> <td colspan="2" valign="top" width="143"> <p><i>xx/xx/xxxx </i></p> </td> </tr> <tr> <td rowspan="2" valign="top" width="47"> <p>11</p> </td> <td rowspan="2" valign="top" width="289"> <p><b>Ratings and rating endorsements</b> held </p> </td> <td colspan="2" valign="top" width="135"> <p><b>Ratings and rating endorsements</b></p> </td> <td colspan="2" valign="top" width="143"> <p><b>Date of first issue</b></p> <p><b>(dd/mm/yyyy) </b></p> </td> </tr> <tr> <td colspan="2" valign="top" width="135"> <p><i>e.g. </i></p> <p><i>ADI</i></p> <p><i>ACS</i></p> <p><i>RAD</i></p> <p><i>PAR</i></p> </td> <td colspan="2" valign="top" width="143"> <p><i>xx/xx/xxxx </i></p> </td> </tr> <tr> <td rowspan="3" valign="top" width="47"> <p>12</p> </td> <td rowspan="3" valign="top" width="289"> <p>Remarks, i.e. <b>licence endorsements relating to language proficiency level and validity</b> (English, others) </p> </td> <td colspan="4" valign="top" width="279"> <p><b><i>Language proficiency</i></b><i> endorsements </i></p> </td> </tr> <tr> <td valign="top" width="91"> <p><i>Language </i></p> </td> <td colspan="2" valign="top" width="89"> <p><i>Level </i></p> </td> <td valign="top" width="99"> <p><i>Validity (dd/mm/yyyy) </i></p> </td> </tr> <tr> <td valign="top" width="91"> </td> <td colspan="2" valign="top" width="89"> </td> <td valign="top" width="99"> </td> </tr> <tr> <td valign="top" width="47"> <p>13</p> </td> <td valign="top" width="289"> <p>Past or pending enforcement action* </p> </td> <td colspan="4" valign="top" width="279"> <p><b>Yes</b> o <b>No</b> o (If yes, please provide details on a separate page.) </p> </td> </tr> <tr height="0"> </tr> </table> \* *Item 13*: Specify whether there is an ongoing investigation into the medical certificate and licence, or its suspension or revocation. *[applicable from 4 August 2024 - ED Decision 2023/011/R]*