Form 464, Application, A, B1 or B2 Category Airworthiness

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Form 464, Application, A, B1 or B2 Category Airworthiness Powered By Docstoc
					                                                                   A, B1 or B2 Category Airworthiness Authority
                                                                   Application for Issue/Addition of Category or
                                                                                      Ratings (Refer to CAO 100.66)
 All applicants need to provide a Form 465 – A, B1 or B2 notification of Training Outcomes to CASA from a recognised
 organisation. Form 465 training outcomes are cross checked against CASA records.
 Tick appropriate box:          Initial Issue:                    Complete sections 1 to 5
                                Additional Rating(s)              Complete sections 1 to 5
                                Revalidation:                     Complete sections 1 and 5 only
1. Personal and Contact Details
 Title              Surname                                              Given Names

 ARN or Licence Number                   Date of Birth                   Nationality
                                         ……./……./
 Residential Address                                                     Postal Address (if different to Residential)



 Postcode                                                                Postcode
 Employer’s Name and Address

 Email Address

 Work Phone                                     Home Phone                                       Mobile Phone

2. Authority Category (A, B1 or B2) or Ratings Applied For
         •     An application for a B1 sub-category automatically includes the associated A sub-category.
         •     An application for a B2 automatically includes an application for a limited B1.
         •     Recognised Organisation needs to have certified that experience requirements have been met - using CASA Form 465
                                         Applicant Use                                                            CASA Use

  Category:                                                                                           Exclusions                Initial
 Sub Category            A1.1       A1.2                 B1.1       B1.2               B2
                                                                                                            E1       E2
                         A1.3       A1.4                 B1.3       B1.4
                                                                                                            E3       E4

  Type Rating
                                                                                                            Y        N

     AAC 9-66
                                                                                                            Y        N
   provides the
 list and form of
       ratings                                                                                              Y        N

                                                                                                            Y        N

                                                                                                            Y        N

 3. Basis of rating application
 A.       Notification of Training Outcome from a Recognised Organisation                    (for category or ratings)
 B.       Foreign Licence (provide a certified true copy of the foreign licence and ratings) (for ratings)
 C.       CAR31 licence.                                                                     (for ratings)

 4. Payment Details – Use payment area on page three of this form.

5. Declaration by Applicant. I hereby certify that all statements in this application are true and correct in every particular
and that I have read and understand all Civil Aviation Regulation requirements relevant to this application and I do not suffer
from any disability that is likely to affect the exercise of the maintenance authority being applied for. I acknowledge that to
knowingly make a false statement is an offence against the Criminal Code Act 1995.
 Applicant’s Signature



 Date: ……./……./…………


Form 464 03/2009         A, B1 or B2 Category Airworthiness Authority Application for Issue/Addition of Category or Ratings   Page 1 of 3
 CASA Use Only

 Examination Credits Satisfactory (AA)                 Yes      No     Folio ____

 Proof English communication                           Yes      No     Folio ____

 Experience Satisfactory                               Yes      No     Folio ____


 Proof of Age and ID Satisfactory                                      Folio ____
                                                       Yes      No
 Authority Permissions/Conditions (Use if not covered in Section 1)

 Permissions:      P1        P2

 Conditions/Notes:




 Approving Delegate’s Signature:               Name:                                            Date

                                                                                                          ……./……./………

 Date Payment Received:                        Amount Paid:                                     Receipt No:

 ……./……./………

 AIRS updated and licence issued:                Yes                   Photocopy of Authority on File at folio …………….




Form 464        A, B1 or B2 Category Airworthiness Authority Application for Issue/Addition of Category or Ratings   Page 2 of 3
03/2009
                                                                              Estimate/Payment Authorisation Form


 Licence Holder’s Name:

 ARN / Licence Number:

Use fee regulation details below to work out the cost of the application.
Note: Where an hourly fee estimate is subsequently revealed to be over/under estimated the applicant will be
invoiced or rebated the fee difference.
CAO 100.66 Category – subcategory and type ratings applications
        Issue of a maintenance authority in 1 or                       HR fee @ $190.00 - CASA processing time                              $
        more of the categories or subcategories                        estimation 1 hour, consequently fee estimate
        mentioned in subsection 3 of Civil Aviation                    $190.
        Order 100.66 – processing and
        consideration of application –
        Fees Reg 2.18
        Issue of 1 or more ratings on a                                HR fee @ $190.00 - CASA processing time         $
        maintenance authority under subsection 16                      estimation 1 hour, consequently fee estimate
        or subsection 17 of Civil Aviation Order                       $190. If application is made concurrently with
        100.66 – processing and consideration of                       the issue of a Fees Reg 2.18 (category/sub
        application – Fees Reg 2.19                                    category) then no additional estimated cost.
        Verification of information about a                            HR fee @ $190.00 - CASA processing time         $
        maintenance authority for the purposes of                      estimation 1 hour, consequently fee estimate
        validation or revalidation of the authority                    $190. If application is made concurrently with
        under subsection 7 of Civil Aviation Order                     the issue of a Fees Reg 2.18 (category/sub
        100.66 – Fees Reg 2.20                                         category) or Fees Reg 2.19 then no
                                                                       additional estimated cost.
                                                                                                            Total cost $

Payment Authorisation
 Form of Payment (tick appropriate box):                   Cheque                Credit Card                Cash           (Do not send by mail)
I authorise the Civil Aviation Safety Authority to debit the following amount from my:
Mastercard             Bankcard              Visa

                                     Card Number

                      Expiry Date …..../……..                                                          Amount ……………………..

Card Holder Name (please print) .......................................................................................................................
Signature                                                                                  Date: ……./……./…………
 PAYMENT OPTIONS:
    •  ATTACH THIS PAYMENT ADVICE (AND CHEQUE, MONEY ORDER) TO THE APPLICATION FORM.
    •  POST TO: MAINTENANCE REGULATIONS TEAM - CASA, GPO BOX 2005, CANBERRA ACT 2601.
    •  FAX TO 02 6217 1443 (+61 2 6217 1443 from outside of Australia).
    •  PHONE (CREDIT CARD PAYMENT ONLY) TO CLARC AT 1300 737 032 (+61 2 6217 1449 from outside Australia).


CASA Use Only

 CASA Receipt number:                                                                                Amount Paid: $




Form 464 03/2009           A, B1 or B2 Category Airworthiness Authority Application for Issue/Addition of Category or Ratings                 Page 3 of 3

				
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Description: Form 464, Application, A, B1 or B2 Category Airworthiness