CIVIL AVIATION AUTHORITY OF SRI LANKA



CIVIL AVIATION AUTHORITY OF SRI LANKA

APPLICATION FOR THE ISSUANCE OF ATC LICENCE

I. Personal Particulars

1. Name in full: Mr./ Ms. EEEEEEEEE, XXXXX, XXXXXX …………………………..……...

……………………………………………………….………………………..…………

(Block letters, Surname first)

2. Permanent Address: 001, Main Street, Colombo 01. …………………………………..……………

………………………………………………………………..……..……………

3. Sex : Male/ Female …………………………………………………………..…..…………………

4. Date of Birth: 01.10.2011 ……………………………………………………………………………

5. Telephone No: 011 2345678 ………………… E-mail Address: aaa@ abc. ……………

II. Professional Particulars

6. Date of appointment: 01.01.2011 ………….…………………………………………………..…….

7. Date of Medical Examination: 01.01.2011 …….…….……………………………………………...

III. Training Details

8. Theoretical Course

|Title of the course/ Details of the course |Country/ venue |Date of commencement |Date of completion |

| | | | |

|(Name of the Course) |(Name of country course |01.01.2011 |31.12.2011 |

| |followed ) | | |

| | | | |

9. On-the-job Training

|OJT training & Name of the instructors |OJT centre |Date of commencement |Date of completion |

| | | | |

|Mr. A B C xyz |Ratmalana |01.01.2012 |31.03.2012 |

| | | | |

| | | | |

10. Date of the Rating Assessment Test: 01.04.2012 ………………….……………………………….

11. Rating Test results: Pass ……………………………………………………………………………

12. Attached following documents:

I. certified copy of the course completion certificate

II. Details of the training course (Subjects followed, venue , duration)

III. OJT Assessment Report

IV. Rating Assessment Results

V. Letter of appointment from AASL

I received Pamphlet No. PL/P/07.

I hereby confirm that the above particulars given by me are true and correct.

……… 16.05.2009 …. …………………………..

Date Signature of Applicant

I certify that entries in 8-11 are correct.

……… 16.05.2009 ……. …………………………..

Date Head of Air Navigation Services

………………………………….. …………………………

Delivery Date Delivery Time

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