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AMC 21.B.520(b) Application for a permit to fly

Available versions for ERULES-1963177438-4093

ED Decision 2012/020/R found in: Initial Airworthiness and Environmental Protection (748/2012) Part-21 Part-21L (Jul 2024)

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AMC 21.B.520(b) Application for a permit to fly

ED
Decision 2012/020/R

The
competent authority must receive an application for permit to fly in a form
and manner established by that authority, e.g. on EASA Form 21 (see below)
completed by the applicant.

<table border="1" cellpadding="0" cellspacing="0" width="604">
<tr>
<td colspan="3" width="604">
Application for
 Part 21 Permit to Fly
</td>
</tr>
<tr>
<td width="189">
1.  Applicant:
</td>
<td colspan="2" width="415">
[Name of applicant]
</td>
</tr>
<tr>
<td width="189">
2.  Aircraft nationality and identification marks:
</td>
<td colspan="2" width="415">
</td>
</tr>
<tr>
<td width="189">
3.  Aircraft owner:
</td>
<td colspan="2" width="415">
</td>
</tr>
<tr>
<td colspan="2" width="286">
4.  Aircraft manufacturer/type
</td>
<td width="318">
5. Serial number
</td>
</tr>
<tr>
<td colspan="3" width="604">
6.  Purpose of flight
[Use terminology of <a href="#_DxCrossRefBm1649097379">21.A.701</a>(a) and add
 any additional information for accurate description of the purpose, e.g.
 place, itinerary, duration…]
[For an
 application due to a change of purpose (ref. <a href="#_DxCrossRefBm1649097475">21.A.713</a>): reference to initial request
 and description of new purpose]
</td>
</tr>
<tr>
<td colspan="3" width="604">
7.  Expected target date(s) for the flight(s) and duration
</td>
</tr>
<tr>
<td colspan="3" width="604">
8.  Aircraft configuration as relevant for the permit to fly
8.1     The above aircraft for which a permit to fly is requested is
 defined in [add reference to the document(s)
 identifying the configuration of the aircraft. Same as required in <a href="#_DxCrossRefBm1649097385">AMC 21.A.263(c)(6)</a> or <a href="#_DxCrossRefBm1649097282">AMC 21.A.709(b)</a> application approval
 form 18A or 18B, box 6]
8.2     The aircraft is in the following situation related to its
 maintenance schedule:
[Describe status]
</td>
</tr>
<tr>
<td colspan="3" width="604">
9.  Approval
 of flight conditions [if not available at the
 time of application, indicate reference of request for approval]
[Reference to:
1.   EASA
 approval, if flight conditions are approved by EASA; or
2.   DOA approval form (see <a href="#_DxCrossRefBm1649097385">AMC
 21.A.263(c)(6)</a>), if approved under DOA privilege; or
3.   Competent
 authority approval.
</td>
</tr>
<tr>
<td colspan="2" width="286">
10.   Date:
</td>
<td width="318">
11.  Name
 and signature:
[Authorised signatory]
</td>
</tr>
<tr height="0">
</tr>
</table>

EASA
Form 21

##### AMC 21.B.520(b) Application for a permit to fly

*ED
Decision 2012/020/R*

The competent authority must receive an
application for permit to fly in a form and manner established by
that authority, e.g. on EASA Form 21 (see below) completed by the
applicant.

<table cellpadding="4" cellspacing="0">
<col/>
<col/>
<col/>
<tr>
<td colspan="3">
Application
			for Part 21 Permit to Fly
</td>
</tr>
<tr>
<td>
1. Applicant:
</td>
<td colspan="2">
[Name
			of applicant]
</td>
</tr>
<tr>
<td>
2. Aircraft
			nationality and identification marks:
</td>
<td colspan="2">
 

</td>
</tr>
<tr>
<td>
3. Aircraft
			owner:
</td>
<td colspan="2">
 

</td>
</tr>
<tr>
<td colspan="2">
4. Aircraft
			manufacturer/type
</td>
<td>
5. Serial
			number
</td>
</tr>
<tr>
<td colspan="3">
6.	Purpose
			of flight

[Use
			terminology of <a href="#_DxCrossRefBm485230871">21.A.701</a>(a)
			and add any additional information for accurate description of the
			purpose, e.g. place, itinerary, duration…]

[For
			an application due to a change of purpose (ref. <a href="#_DxCrossRefBm485230968">21.A.713</a>):
			reference to initial request and description of new purpose]
</td>
</tr>
<tr>
<td colspan="3">
7. Expected
			target date(s) for the flight(s) and duration
</td>
</tr>
<tr>
<td colspan="3">
8. Aircraft
			configuration as relevant for the permit to fly

8.1	The
			above aircraft for which a permit to fly is requested is defined
			in [add reference to the document(s) identifying the
			configuration of the aircraft. Same as required in <a href="#_DxCrossRefBm485230877">AMC
			21.A.263(c)(6)</a> or <a href="#_DxCrossRefBm485230773">AMC
			21.A.709(b)</a> application approval form 18A or 18B,
			box 6]

8.2	The
			aircraft is in the following situation related to its maintenance
			schedule:

 


[Describe
			status]
</td>
</tr>
<tr>
<td colspan="3">
9.	Approval
			of flight conditions [if
			not available at the time of application, indicate reference of
			request for approval]

 


[Reference
			to:

1.	EASA
			approval, if flight conditions are approved by EASA; or

2.	DOA
			approval form (see <a href="#_DxCrossRefBm485230877">AMC
			21.A.263(c)(6)</a>), if approved under DOA privilege;
			or

3.	Competent
			authority approval.
</td>
</tr>
<tr>
<td colspan="2">
10.	Date:

 


 


 

</td>
<td>
11.	Name
			and signature:

 


[Authorised
			signatory]

 

</td>
</tr>
</table>

***EASA
Form 21***

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