! !
!
!"#$%&'()'%*+,("#-.%,(/!)"0(&""'%$&,%12()1-.(
)345(%2!6789:7( ";<=(>(3?(>( -=@8(9>(A(&B<8(C9>7((
A.# DETAILS#OF#AIRCRAFT:#
#
1.! Operator:! !___________________________________________________________________________________________________________!!
2.! Address:! !___________________________________________________________________________________________________________!!
3.!! City:!__________________________________________________!! 4!!!Country:! _______________________________________________!!
5.! Registration!Mark:!!P4> ! ____________________________!! 6.!!!Aircraft !Manufa ct urer:!!______________________________!!
7.! Model:!_______________________________________________!! 8.!!!Serial!No.:!!_____________________________________________!!
B.# DESCRIPTION#OF#FLIGHT:#(PROV IDE !NA M E!AN D !ICAO !CO DE !OF!A IRPO R TS) #
#
1.! Type!of!flight:! !Ferry!flight! !Test!flight!(Nr.!Of!flights:____)! !Ferry!and!Test!flight!
2.! From:!! _______________________________________________!! 3.!!!To:!!_____________________________________________________!!
4.! Via:! !___________________________________________________________________________________________________________!!
5.! Departure!date:!!____________________________________!! 6.!!!Estimated!duration:!!_________________________________!!
7.! Flight!into!RVSM!airspace:!
!Yes!!!! !No!
C.# CREW#REQUIRED#TO#OPERATE#THE#AIRCRAFT#AND#ITS#EQU IP MENT:#
#
1.! Number!of!!on!board:!_______________________̴̴̴̴̴̴̴!!
! Name! License/validation!Nr.! Function:!
1! ! ! !
2! ! ! !
3! ! ! !
4! ! ! !
5! ! ! !
D.# THE#REASON#FOR#THE#SPECIAL#FLIGHT#PERMIT#APPLICATION:#
!!____________________________________________________________________________________________________________________________!!
!!____________________________________________________________________________________________________________________________!!
!!____________________________________________________________________________________________________________________________!!
E.# THE#AIRCRAFT#DOES#NOT#MEET#THE#FOLLOWING#APPLICABLE#AIRWORTHINESS#REQUIREMENTS:#
!!____________________________________________________________________________________________________________________________!!
!!____________________________________________________________________________________________________________________________!!
F.# THE#FOLLOWING#RESTRICTIONS#ARE#CONSIDERED#NECESSARY#FOR#SAFE#OPERATION:#
!!____________________________________________________________________________________________________________________________!!
!!____________________________________________________________________________________________________________________________!!
G.###DE C LARATION:#
!
Hereby!declare!that!all!statements!provided!in!this!application!are!true!and!correct!in!every!respect!and!that!
I!shall!adhere!to!all!a pplicable!Aruban!regulations.#
!
Date.(day/month/year):!!________________________________ ...Position:!!_________________________________________________!!
Name:!! ____________________________________________________!! Signature:!!_______________________________________________!!
!
